Page 89 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Consequently, after using the most accurate method for GER analysis, we can now more certainly say that GP in general is not associated with an increase in pathological GER.
Many children requiring GP have coexistent GER, especially those with NI. 27 This is also found in our study showing a high percentage of pathological GER before GP (72%). In earlier days it was suggested that in children with pathological GER before GP a concomitant fundoplication was needed, even though this operation is associated with possible additional adverse event. 28 In our current study none of the patients with postoperative pathological reflux required antireflux surgery during follow-up. Moreover, in 22% of patients with preoperative pathological GER, this pathological GER had disappeared after GP. This is in line with two other studies that showed that pathological GER dissolved in a significant number of patients after GP without concomitant fundoplication. 12,29 These results justify that routine fundoplication in present day is no longer used as a standard procedure in children with pathological GER on preoperative measurements. As a result, routine preoperative workup for GP does not have to include assessment studies for GER.
In subgroup analysis of patients without preoperative GER, total acid exposure and the number of reflux episodes lasting longer than 5 minutes increased slightly. It is questionable whether these small differences of 1.9% (0.1 – 3.8) and 1.3 (0.2 – 2.4) are clinically relevant. However, it is noteworthy that GER seems to slightly increase in some patients without preoperative pathological GER.
We found that children with poor preoperative nutritional status were at greater risk of an increase in acid exposure after operation. Age and neurologic impairment were not predictive of increased acid exposure.
GER symptoms reported in the GSQ were not associated with pathological GER on MII-pH analysis. Similarly, symptom association in the MII-pH metry was low in the majority of patients. This is consistent with current knowledge: many of the reflux episodes detected with diagnostic tests go unnoticed clinically; conversely, not all symptoms are detected on diagnostic tests. 30 This underlines the importance of reliable diagnostic tests for GER.
We found that preoperative total acid exposure was correlated with preoperative gastric half-emptying time. Also, an increase in the one correlated with an increase in the other. These results suggest that delayed GE may influence the occurrence of GER after GP. However, postoperative values did not correlate. Delayed gastric emptying has been thought to accentuate postprandial reflux by increasing the volume of refluxate per episode of reflux (through an incompetent lower esophageal sphincter). 31 Our results support the hypothesis that delayed GE is one of the pathogenic factors of GER in children.
Chapter 5
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