Abstract
PurposeGastrostomy tube (GT) insertion is commonly performed in children with failure to thrive. Pediatric patients' frequently have gastroesophageal reflux (GER) and discerning pathological GER can be challenging. Moreover, there is some evidence that GT insertion may lead to worsening GER and to avoid a subsequent anti-reflux procedure (ARP), though controversial some surgeons advocate considering an ARP concomitantly. The purpose of this report is to assess outcomes in infants who underwent a GT vs. GT with ARP.MethodsRetrospective review of all infants who had a GT placed at a single institution from 2009–2014. The patients were then divided into two cohorts based on the index operation i.e., GT vs GT with ARP and outcomes compared.Results226 operations (104 GT, 122 GT with ARP) were performed. The cohorts were similar in gender, gestational age, race, weight, median age, LOS, and proportion of neurologically impaired patients. Preoperative GER was significantly higher in the GT with ARP cohort (91 vs. 18%). No difference in the rate of immediate complications was noted between the two groups. Postoperative increase in anti-reflux medications was significantly higher in the GT cohort (p = 0.01). Post-op GER needing a secondary procedure (ARP or GJ tube) was noted in 21/104 (20%) patients. Those needing an additional procedure vs. those with GT alone were similar in the proportion of patients with pre-op GER, neurologic impairment, type of feeds, and age.ConclusionIdentifying patients who would benefit from a concomitant ARP remains challenging. A fifth of GT patients needed a subsequent procedure despite most high-risk patients having already undergone an ARP. Since the overall rate of complications remained similar, initial GT approach can be considered reasonable.
Highlights
A large number of infants aged less than 5 months of age have some degree of gastroesophageal reflux (GER), this progressively decreases over time to less than 5% of the population by a year of age [1]
There was a significantly higher rate of clinical preoperative GER recorded in patients in the anti-reflux procedure (ARP) group (91 ARP vs. 18% Gastrostomy tubes (GT), p < 0.0001)
There were no differences in the age (2.75 months GT vs. 2.15 months ARP, p = 0.93) or weight (3.9 kg GT vs. 4.25 kg ARP, p = 0.54) of the patients at the time of the index operation
Summary
A large number of infants aged less than 5 months of age have some degree of gastroesophageal reflux (GER), this progressively decreases over time to less than 5% of the population by a year of age [1]. Reported symptoms of infant GERD vary widely and may include excessive crying, back arching, regurgitation and irritability. Since these symptoms vary widely by age and are non-specific establishing temporal relationship of these symptoms to reflux events becomes very difficult. This is applicable to non-verbal infants in whom many of these symptoms occur with or without GERD and defining what is considered troublesome becomes challenging which in turn makes establishing a diagnosis of GERD difficult. While there is a myriad of diagnostic tests such as contrast imaging, biomarkers, esophageal manometry, pH probe studies, esophagogastroduodenoscopy with/without biopsy, scintigraphy etc. used in clinical practice there is no clear established gold standard and several lack sufficient evidence to support use in the evaluation and management of pediatric patients with GERD [2]
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