Page 88 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Postoperative increase in gastric half-emptying time was correlated with both an increase in total acid exposure and an increase in number of reflux episodes lasting longer than 5 minutes (p=0.03 and p=0.03).
nutritional status
Weight-for-height scores did not significantly change during the follow-up period of 3.9 months: from the 30.0th percentile (1.0 – 85.0) to the 55.0th percentile (25.0 – 82.0) with a mean difference of 5.2 (-8.3 – 18.8). Similarly, height-for-age scores did not significantly change: from the 2.0th percentile (0.6 – 16.0) before operation to the 8.0th percentile (0.4 – 25.0) after operation with a mean difference of 2.9 (-1.9 – 7.7)
There was no correlation between acid exposure time and either weight-for-height percentiles (rs 0.18; p=0.42) or height-for-age percentiles (rs 0.15; p=0.48).
DisCUssion
This prospective, longitudinal cohort study demonstrated that laparoscopic GP does not cause an overall increase in GER on 24-hour MII-pH monitoring. The total number of patients with pathological GER remained similar after operation. Although all pH-metry reflux parameters decreased and all MII parameters increased, none of these changes were statistically significant. These results underline the hypothesis that GP is not associated with an increase in pathological GER.
Previous studies on this subject have been contradictory. While some studies suggest a worsening or development of esophageal acid exposure after operation 7,10 other studies show no change or decreased GER. 11,12 In line with our findings on pH-metry, Kawahara et al. found that that esophageal acid exposure increased in patients without pathological GER after GP on traditional 24-hour pH monitoring, but decreased in those with pathological GER. 25
Previous studies were performed using conventional 24-hour pH metry. In this current study we used 24-hour MII-pH metry, enabling us to detect passage of acid reflux, weakly acidic and non-acid reflux, as well as liquid refluxes and mixed liquid–gas refluxes. In children weakly and non-acidic reflux occur more frequently compared to the adult population 26 and these cannot be detected by conventional 24-pH metry. Analysis of MII tracings in our cohort did not identify a significant change in GER after GP in the cohort as a whole.
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