Page 79 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
A gastrostomy placement (GP) is an effective procedure that provides long-term enteral tube feeding in children with feeding difficulties. 1,2 The main underlying diseases that require GP are neurological impairment (NI), cystic fibrosis and congenital cardiac disease. 3,4 GP enables successful feeding in 96% of patients, 4 however, it is not without complications. Complications such as leakage and gastrostomy site infection are commonly seen and described. 5
The development or deterioration of gastroesophageal reflux (GER) after GP is a widely discussed adverse event of GP. 6 It is important to consider the effect of GP on GER since a high proportion of patients who receive GP have impaired neurodevelopment 3,5 and are therefore already at risk of GER. 7 Possible consequences of GER in pediatric patients include esophagitis and aspiration with or without pneumonia. 8 Furthermore, chronic GER is a risk factor for the development of Barrett esophagus and adenocarcinoma of the esophagus. 9 Due to its widespread consequences, it is important to evaluate if GP increases GER in children. Although in most cases children have few alternatives for GP, patients, caregivers and pediatric surgeons need to know the consequences of this operation.
Few prospective studies have used 24-hour pH metry to compare pre- and postoperative GER after GP. 6 While some studies suggest a worsening or development of esophageal acid exposure after operation 7,10 others show no change or even decrease in GER. 11,12 The majority of evidence has been of low quality, as described in detail by a systematic review of Noble et al. 6 Consequently, no consensus currently exists on the topic of GER and GP.
Until recently, pH monitoring was considered the gold standard for GER measurement. However, the development of multichannel intraluminal impedance (MII) combined with pH monitoring has greatly improved diagnostic possibilities of GER in both children and adults. 13-15 This technique detects changes in electrical impedance between two electrodes during the passage of a bolus. The main advantage of MII-pH over traditional pH monitoring is the ability to detect acid, weakly acidic and non-acid reflux episodes and to differentiate between liquid and gas movements within the esophageal lumen. 15,16 It has been demonstrated that most reflux episodes occurring in children are undetectable by standard pH-only monitoring. Combining pH monitoring with MII is therefore valuable and possibly superior to pH-only measurements especially when diagnosing GER in children. 17
The aim of this study is to evaluate the effect of GP on GER in children with the 24-hour MII-pH monitoring.
Chapter 5
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