Page 131 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Chapter 8
In chapter 5 a prospective, longitudinal cohort was presented analyzing GER in 50 patients with symptom questionnaires and 24-hour multichannel intraluminal impedance (MII) - pH metry before and 3 months after laparoscopic GP. Twenty-five out of 50 patients successfully underwent both tests. Total acid exposure in the esophagus did not change significantly after GP: from 6.2% (3.0 – 18.1) to 6.1% (2.6 – 14.9). The number of reflux episodes did not change, neither for liquid and mixed liquid-gas reflux, nor for acid and weakly acid reflux.
The number of patients with pathological GER did not change after GP (18 out of 25 = 72%). Pathological GER dissolved after operation in some patients (n=4), while other patients developed pathological GER in the same amount (n=4). A postoperative delay in gastric emptying was correlated with an increase in total acid exposure. Low preoperative weight-for-height percentile predicted increased acid exposure after GP.
GER symptoms reported in reflux questionnaires were present in a comparable number of patients before (44%) and after GP (40%; p = 0.73). Symptoms were not associated with pathological GER on MII-pH analysis.
Results are in line with the large retrospective survey including 300 children in chapter 2, in which the incidence of GER symptoms remained unchanged: 57.8% preoperatively and 54.2% postoperatively. Antireflux surgery secondary to GP in these 300 children was indicated in only 0.7%. Sensitivity of preoperative 24-hour pH monitoring for predicting postoperative GER was only 17.5%.
These results underline the hypothesis that, overall, GP does not induce GER.
iV. Health-related quality of life
The two most important aims when placing a gastrostomy are improvement of nutritional status and improvement of HRQoL. 12,13 No previous studies have been performed on HRQoL in children undergoing GP using validated questionnaires.
Chapter 6 offers a large prospective cross-sectional study including 126 patients who underwent laparoscopic GP. Caregivers filled out the validated PedsQLTM 4.0 generic core scales. After a median follow-up time of 4.0 years, mean HRQoL was 53.0 out of 100 (± 21.1) on a 100-point scale. For comparison: mean of a normal reference population is 82.7 (± 15.4). 14 Lowest HRQoL values were found in NI children. Feeding through a gastrojejunostomy tube was predictive of lower HRQoL. Gastrostomy-related complications were not predictive of HRQoL (p=0.06).
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