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The development of gastroesophageal reflux after percutaneous endoscopic gastrostomy
J A Isch1, F J Rescorla, L R Scherer
1Department of Surgery, Indiana University, JW Riley Hospital for Children, Indianapolis 46202, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) tubes are safe for children, with a low risk of developing gastroesophageal reflux (GER). Even with radiographic GER, PEG placement is reasonable if clinical GER is absent.
Area of Science:
- Pediatric Gastroenterology
- Surgical Procedures
- Gastrointestinal Motility Disorders
Background:
- The link between percutaneous endoscopic gastrostomy (PEG) and gastroesophageal reflux (GER) in children is not fully understood.
- PEG tubes are frequently used for nutritional support in pediatric patients.
Purpose of the Study:
- To evaluate the incidence of new-onset or persistent gastroesophageal reflux (GER) after percutaneous endoscopic gastrostomy (PEG) placement in children.
- To assess the need for surgical intervention for GER post-PEG.
Main Methods:
- Retrospective review of 82 children undergoing PEG tube or PEG button placement over 5 years.
- Preoperative and postoperative evaluation for clinical GER (C-GER) and radiographic GER (R-GER) using upper GI series or gastric scintigraphy.
- Postoperative GER assessment via family contact.
Main Results:
- 28% of patients without preoperative GER developed it post-PEG; 20% required Nissen fundoplication (NF) or gastrojejunostomy (GJ) tube.
- 53% with preoperative C-GER but no R-GER had persistent GER, with 3 requiring NF or GJ.
- Only 1 of 9 with R-GER only developed GER post-PEG.
- Among those with both C-GER and R-GER, 25% required NF or GJ, and 25% had no postoperative GER.
Conclusions:
- PEG tubes are valuable in pediatric care with a low incidence of postoperative GER.
- PEG placement is a reasonable option even with radiographic GER if clinical GER is absent preoperatively.
Abstract:
The relationship between percutaneous endoscopic gastrostomy (PEG) and subsequent development of gastroesophageal reflux (GER) is complex and not well understood. The authors retrospectively reviewed 82 children over a 5-year period who underwent PEG tube (n = 64) or PEG button (n = 18) placement. Children were evaluated preoperatively for clinical evidence of GER (C-GER) or radiographic GER (R-GER) with upper gastrointestinal contrast study or Tc99m gastric scinitiscan. Seventy-five patients were evaluated for clinical evidence of postoperative GER by direct family contact. Eleven of 39 (28%) patients with no GER preoperatively developed GER postoperatively, eight (20%) of whom required Nissen fundoplication (NF) or gastrojejunostomy (GJ) tube. Ten of 19 (53%) with preoperative C-GER but no R-GER continued to have GER after PEG, but only three required NF or GJ. Only one of nine children who had R-GER only developed clinical GER after PEG placement. Of the eight children with both C-GER and R-GER, only two (25%) required NF or GJ and two (25%) had no postoperative GER. The authors conclude that PEG tubes are useful in infants and children and are associated with a relatively low incidence of postoperative GER. If C-GER is absent, a PEG is a reasonable procedure to consider even in the presence of R-GER.