Unexpected Malrotation in Patients with Congenital Heart Disease Undergoing Gastrostomy Tube Placement: Is Routine...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Cardiology

Background:

• Infants with congenital heart disease (CHD) often require gastrostomy tube (GT) placement.
• Preoperative upper gastrointestinal (UGI) contrast studies are sometimes performed before GT placement in these infants.
• The utility and impact of routine UGI studies in this population are not well-defined.

Purpose of the Study:

• To determine the rate of unexpected malrotation identified on preoperative UGI studies in infants with CHD prior to GT placement.
• To quantify any associated delay in care.
• To evaluate the value of routine UGI contrast studies in this specific patient group.

Main Methods:

• Retrospective review of infants with CHD who underwent GT placement after cardiac surgery between 2016 and 2021.
• Collection of demographic information, indications for GT placement, and clinical course.
• Comparison of variables using Mann-Whitney test, with significance set at p < 0.05.

Main Results:

• 131 infants with CHD underwent GT placement; 124 had preoperative UGI studies.
• Only one infant (0.8%) was diagnosed with malrotation on UGI.
• Median time from UGI to surgery was 3 days; no significant delay in GT placement was observed between groups with and without UGI (p=0.34).

Conclusions:

• The rate of unexpected malrotation identified by routine preoperative UGI studies in infants with CHD prior to GT placement is low.
• Routine UGI contrast studies may be associated with surgical delay, unnecessary radiation exposure, and low-value healthcare.
• UGI studies may be unnecessary if the infant is tolerating gastric feeds prior to GT placement.