Where have all the fundoplications gone? A look at changes in national practice in England (April 2012-March 2024)

Fundoplication (FP) and transgastric jejunal tubes (GJ) are treatments for gastro-oesophageal reflux disease (GORD) where medical management has failed. GJ is less invasive than FP but requires regular radiological replacement of the tubes. We aim to assess trends in paediatric FP and GJ in England.

Data were obtained from the NHS England digital platform for procedures and interventions using OPCS-4 codes G24.3 [antireflux fundoplication using abdominal approach] and Y51.2 [approach to organ through gastrostomy] from April 2012 to March 2024 for children ≤15 years. Spearman's correlation and traditional model forecasting were performed on SPSS v29. Age-based subgroup analysis was also performed [<1, 1-4, 5-9, 10-14, 15 years].

The annual mean for FP was 286 (IQR: 193-371, SEM: 27), and for GJ it was 342 (IQR: 78-529, SEM: 62). Since 2012, FP has steadily decreased, while GJ has steadily increased. GJ has become more frequent than FP since 2017. Age-based subgroup analysis revealed similar trends across all age groups, except for infants under one year, where the FP decreased, while GJ remained stable and lower than FP. Spearman's test showed a strong negative correlation between FP and GJ (R = -0.83; P < 0.001). The forecasting analysis indicates that no FP will be performed on children in England after 2029 if the current trend continues.

Currently, GJ is performed more frequently than FP, thereby increasing the cumulative number of children requiring regular tube replacements.