The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

Abstract

Objectives: To evaluate the outcomes of fundoplication and gastrostomy (GT) in neurologically impaired (NI) children. Methods: A retrospective review of medical charts was performed on 178 NI children up to the age of 14 years inclusive, who underwent fundoplication and GT between 1999 and 2014. Results: After fundoplication, the incidence-rate (person-month) of all hospital admissions (0.95 versus 0.13; p <0.001), gastroesophageal reflux (GER) - related admissions (0.67 versus 0.09; p <0.001), and admissions for seizures (0.21 versus 0.01; p <0.001 were significantly decreased. Furthermore, all emergency department visits (0.94 versus 0.23; p <0.001), GER visits (0.61 versus 0.12; p <0.001), seizure visits (0.24 versus 0.01: p <0.001) were significantly reduced. The mortality rate after fundoplication was 35%. The risk factors for predicting mortality were being male (odds ratio: 2.2, p =0.027) and being a do not resuscitate (DNR) child (odds ratio: 5.2, p <0.001). Majority of the children that died within a year after the procedure were DNR. Conclusions: Fundoplication with GT is effective in reducing hospital admissions and emergency department visits from GER and seizures in NI children. Because of high mortality within a year of fundoplication with GT in DNR children, anti-reflux medications with GT might be an alternative.

Clinical characteristics of children with severe neurologic impairment: A scoping review

“…The 102 published clinical studies about children with SNI fall into seven clinical topics. Gastroesophageal reflux and feeding tubes ( n = 57, 56%) was the most common topic, with subtopics of gastroesophageal reflux ( n = 7), 7,42–44,102–104 gastrostomy tube outcomes ( n = 24), 9,39,45,46,56–65,81–84,105–110 and antireflux procedures ( n = 26) 8,47–55,66–71,85,86,111–118 . Other topics included aspiration and respiratory issues ( n = 13, 13%) 72,73,87–93,119–122 ; symptoms, palliative care, and quality of life ( n = 12, 12%) 38,41,74–77,94–97,123,124 ; growth and endocrinology ( n = 10, 10%) 78,98,99,125–131 ; caregivers and care burden ( n = 7, 7%) 10,37,40,79,80,100,132 ; other ( n = 2, 2%) 101,133 ; and musculoskeletal ( n = 1, 1%) 134 .…”

“…Gastroesophageal reflux and feeding tubes (n = 57, 56%) was the most common topic, with subtopics of gastroesophageal reflux (n = 7), 7,[42][43][44][102][103][104] gastrostomy tube outcomes (n = 24), 9,39,45,46,[56][57][58][59][60][61][62][63][64][65][81][82][83][84][105][106][107][108][109][110] and antireflux procedures (n = 26). 8,[47][48][49][50][51][52][53][54][55][66][67][68][69][70][71]85,86,[111][112]…”

Causal relationship between gastroesophageal reflux disease, Barrett's esophagus, and epilepsy: A bidirectional Mendelian randomization study

“…Understanding the potential association between GERD and epilepsy by our MR study may help to reduce the likelihood of recurrence in population with epilepsy as well as to prevent and screen for epilepsy early through the prevention or treatment of GERD. Treatment of GERD with fundoplication has demonstrated control of seizure symptoms (AlNamshan et al., 2019 ; Fiorentino et al., 2009 ). As another common treatment for GERD, gastrostomy reduces the rate of seizure hospitalization for patients by 20% after 5 years (Jacoby et al., 2020 ).…”

A Comparison Between the Complications of Laparoscopic and Open Gastrostomy Tube Insertions: A Single-Center Study From Riyadh, Saudi Arabia

“…Several complications have been associated with gastrostomy insertions, and hence choosing the appropriate method of insertion is key to a minimal-risk procedure. Careful assessment of patients' weight, anatomy, and need for general anesthesia or fundoplication prior to the procedure as well as weighing out the complications associated with specific insertions all contribute to the decision-making and, therefore, the outcome of the procedure [ 12 , 13 ].…”