Page 68 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

24-hour pH monitoring was performed in all patients before operation and repeated after gastrostomy in 28 patients (56%). All parents filled out the reflux-specific questionnaires.
symptoms
Almost all patients (49/50) still received gastrostomy feeding at 3 months follow-up. The majority of patients (73%) were able to receive enteral feeding in boluses; the remaining 27% were dependent on continuous drip-feeding (either solely overnight or 24h per day). Seventy percent of patients with gastrostomy feeding received additional oral feeding; the other 30% of patients was entirely dependent on feeding through the gastrostomy tube. Gastrostomy failure, caused by leakage (n=6) and/or feeding intolerance (n=8), occurred in 10 patients (20%) after GP.
Gastroesophageal reflux
After GP, the acid exposure time remained similar (preoperative 6.1% (2.7 – 16.0) and postoperative 6.1% (2.8 – 12.1); p=0.866; n=28). Four patients (14%) developed pathological GER after GP, whereas pathological GER disappeared in the same number of patients. GER symptoms were present in a comparable number of patients before (44%) and after GP (39%) (McNemar p=0.73).
Gastric emptying
After gastrostomy, GE rate significantly decreased compared to preoperative GE rate: the GE percentile and the GE-T1⁄2 both significantly increased (p<0.001 and p=0.03, respectively) and the GEC decreased significantly (p<0.001)(Table 3A).
Table 3A. Gastric emptying before and after GP (n=50)
Legend: 1. Paired T-test.
GE: gastric emptying; GEC: gastric evaluation coefficient; GE-T1⁄2: gastric half-emptying time; IQR: interquartile range; SD: standard deviation
In 26 patients (76.5%), GE was normal before operation. After gastrostomy, 50% of these 26 patients developed DGE (McNemar p=0.01; Figure 2). Before gastrostomy, DGE (P>95) was present in 8 patients. After operation, this number increased to 19 patients (56%; McNemar p=0.01).
Before GP
After GP
p-value1
GE percentile (SD)
57 (± 36.6)
79 (± 30.7)
<0.001
GEC (SD)
3.8 (± 0.90)
3.5 (± 0.86)
<0.001
GE-T1⁄2 (minutes; IQR)
45 (24 – 70)
71 (39 – 94)
0.03
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