Page 71 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

paracetamol at 45 minutes after drug administration. This diagnostic technique still needs further standardization before it can reliably be used for research purposes. 17
Furthermore, results of adult studies cannot be translated to the pediatric population, mainly because indications for GP differ. In the adult population, gastrostomy placements are primarily performed in patients with head and neck malignancies, whereas in the pediatric population, patients often suffer from profound neurological impairment. 18 Generalized gastrointestinal dysmotility is frequently encountered in these patients 19,20 and GI motility changes after GP may consequently differ. Well-designed studies confined to the pediatric population are therefore necessary.
The cause for the delay in GE is not evident. A previous study reported that myoelectrical activity, relevant to gastric motor function, was unaffected after GP. 10 Slow fundic contractions are believed to transfer gastric contents from the fundus to the antrum for trituration and subsequent GE. These contractions might be affected by gastrostomy placement in the gastric body. 21 To clarify the cause for delay in GE, motility tests such as three-dimensional ultrasonography or dynamic contrast-enhanced magnetic resonance imaging of the stomach may be useful.
The effect of a GP on GER has been a matter of profound debate. A systematic review showed that evidence has been inconsistent and of insufficient methodological quality. 22 In our study, the total acid exposure time did not change significantly, supporting previous findings that GER generally does not worsen after GP. 3,22,23
DGE is associated with GER, based on the positive correlation between GE-T1⁄2 and acid exposure time, both before and after gastrostomy. This is in line with previous studies reporting on this pathophysiologic relationship. 24,25 Furthermore, we found that changes in acid exposure time after GP were correlated to changes in GE. Thus, development or worsening of GER after GP, which was frequently reported by other studies 26,27, seems to be influenced by a delay in GE. 28 Other factors may also play a role in the pathogenesis of GER after gastrostomy, e.g. changes in lower esophageal sphincter pressure 29 or the presence of esophageal hiatus hernia. 10.
Postoperative DGE may stimulate problems such as leakage and intolerance of feeding. No previous studies have reported on this causality. According to our findings, most patients with complications of leakage and feeding intolerance were found to have postoperative DGE. Analysis in larger study populations is required to provide more certainty on the causality between DGE and gastrostomy failure.
Chapter 4
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