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Updated: Aug 10, 2025
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Published on: September 22, 2023
Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy
Michael D Williams1, Nicholas Skertich1, Gwyneth A Sullivan1
1Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA.
Insights
Children with neurologic impairment undergoing gastrostomy tube placement have a higher incidence of antireflux procedures. However, the overall rate remains low, suggesting fundoplication should not be based on neurologic impairment alone.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Neurology
Background:
- Fundoplication is often performed in children with neurologic impairment to prevent future feeding intolerance, even without diagnosed reflux.
- Data supporting this practice in the absence of reflux is limited.
Purpose of the Study:
- To determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy tube conversion) after gastrostomy tube placement in children with and without neurologic impairment.
Main Methods:
- A national patient claims database was used to identify children under 18 who underwent gastrostomy tube placement between 2010 and 2020.
- Children with cerebral palsy or degenerative neurologic disease were compared to those without.
- Kaplan-Meier and Cox regression analyses compared the incidence of delayed fundoplication or gastrojejunostomy conversion.
Main Results:
- Out of 14,965 children receiving a gastrostomy tube, 3712 (24.8%) had a neurologic impairment diagnosis.
- Children with neurologic impairment had a higher rate of concomitant fundoplication (9.3% vs 6.4%).
- At 5 years, children with neurologic impairment showed a higher rate of fundoplication or gastrojejunostomy conversion (12.6%) compared to those without (8.6%), though overall incidence remained low.
Conclusions:
- Children with neurologic impairment have a higher likelihood of needing an antireflux procedure or gastrojejunostomy conversion post-gastrostomy tube placement.
- The overall incidence of these secondary procedures is less than 15%.
- Fundoplication should not be performed solely based on neurologic impairment without clinical evidence of reflux.
Purpose:
Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment.
Methods:
Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database. Children with a diagnosis of cerebral palsy or a degenerative neurologic disease were identified and compared to children without these diagnoses. The incidence of delayed fundoplication or conversion to GJ were compared utilizing Kaplan-Meier and Cox proportional hazards regression analyses.
Results:
A total of 14,965 children underwent GT placement, of which 3712 (24.8%) had a diagnosis of neurologic impairment. The rate of concomitant fundoplication was significantly higher among children with a diagnosis of neurologic impairment as compared to those without (9.3% vs 6.4%, p < 0.001). While children with neurologic impairment had a significantly higher rate of fundoplication or GJ conversion at 5 years compared to children without (12.6% [95% confidence interval (CI): 11.4%-13.8%] vs 8.6% [95% CI 8.0%-9.2%], p < 0.001), the overall incidence remained low.
Conclusion:
Although children with neurologic impairment have a higher rate of requiring an antireflux procedure or GJ conversion than other children, the overall rate remains less than 15%. Fundoplication should not be utilized in children without clinical reflux on the basis of neurologic impairment alone.
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