Long-term follow-up of brain-damaged children requiring feeding gastrostomy: Should an antireflux procedure always be performed?

Abstract

Due to the frequent presence of latent gastroesophageal reflux (GER) in mentally impaired children, it is now standard to perform upper gastrointestinal contrast (UGI) and pH probe studies in all children referred for feeding gastrostomy, even if they are without clinical evidence for GER. For patients with documented GER, an antireflux operation performed in conjunction with gastrostomy is usually considered mandatory. Some authors have suggested that a "protective" antireflux operation be performed at the time of gastrostomy placement in all brain-damaged children, citing a high incidence of postoperative GER in this group of patients following gastrostomy, even with a negative preoperative evaluation for GER. To evaluate this theory, we prospectively studied, over the past 6 years, all mentally retarded children referred for feeding gastrostomy with UGI contrast and esophageal pH probe studies. In total, 148 children were studied; 105 had a positive evaluation for GER and underwent gastrostomy and antireflux surgery. Of the 43 children with a negative preoperative evaluation for GER, 37 are doing well following gastrostomy alone without clinical reflux at an average follow-up of 21 months. Six of the 43 (14%) developed symptomatic GER occurring at an average of 10 months following gastrostomy placement. Five of these children have been successfully treated with an antireflux operation and the sixth patient has been successfully managed nonoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Babies with brain damage who can not swallow: surgical management

“…It is a matter of dispute whether a Nissen fundoplication should or should not be associated when performing a Stamm gastrostomy [25][26][27] . We believe that newborns having this particular problem have a high probability of massive reflux, performing a gastrostomy is a potential life-threatening situation, therefore, whenever the clinical status of the babies permit, prophylactic Nissen fundoplication should be associated.…”

Experimental Study Of The Influence Laparoscopic Gastrostomy On The Emergence Of Gastroesophageal Reflux

“…Сообщаемая частота ос-ложнений кнопочной гастростомии (18-23%) де-монстрирует относительную безопасность лапаро-скопических операций [5,6,12,27,29,30] в сравне-нии с 25-40% уровнем возникновения не удач после использования других мини-агрессивных способов установки гастростомических трубок, таких как PEG-гастростомия [3,4,18,[23][24][25]. Симультанные операции по созданию анти-рефлюксных манжет могут потребоваться у значи-тельной части больных, которым предполагается выполнить гастростомию [12,30,31]. Решение о вы-полнении комплексных операций на желудке при-нимается на основании рентгенологических, мано-метрических исследований и pH-метрии.…”

Gastrostomy in Pediatric Patients

“…Consequently, a number of recent publications began advocating selective use of radiologic studies and only in cases when they were highly suspected to change the operative intervention. [8][9][10] In these cases, a focused history and physical exam are essential, designed to elicit symptoms of GERD and gastric feeding intolerance. Although the sensitivity of an UGI to assess GERD is low, it remains the most utilized preoperative modality in evaluation of patients for gastrostomy tube placement.…”

“…Recent literature, however, challenges this notion as well, demonstrating only a 5-7% conversion rate to an antireflux operation, following initial gastrostomy in properly selected patients. [11,12,9] Finally, evidence of delayed gastric emptying may lead to placement of a gastro-jejunostomy tubes, allowing for gastric drainage via the gastric limb, while feeding via the jejunostomy limb. In children with severe respiratory compromise, failure to thrive is common.…”