Efficacy of antireflux surgery in children with or without neurological impairment: a systematic review

Abstract

Background: Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery with regard to objective measures of quality of life (QoL) and value of upper gastrointestinal investigations in neurologically normal (NN) and neurologically impaired (NI) children. Methods: A systematic review was conducted of articles reporting children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. Primarily, Embase, CINAHL, MEDLINE and PubMed were searched from inception to April 2019. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess article quality. Results: Of 789 articles, 14 met the eligibility criteria, 12 prospective observational and 2 retrospective studies. The median MINORS score was 59⋅4 (i.q.r. 39 to 62⋅5) per cent. Seven studies reported assessment of validated QoL measures before and after antireflux surgery in 148 children. Follow-up ranged from 1 to 180 months. All studies confirmed significant improvements in QoL measures among NN and NI children at all follow-up points. Eleven studies reported on preoperative and postoperative investigations in between 416 and 440 children children. Follow-up ranged from 0⋅5 to 180 months. Nine studies confirmed improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry, but conflicting results were identified for four studies reporting gastric emptying. No studies reported fluoroscopy or endoscopy adequately. Conclusion: Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking.

Efficacy and Safety of CAR-Modified T Cell Therapy in Patients with Relapsed or Refractory Multiple Myeloma: A Meta-Analysis of Prospective Clinical Trials

“…The Methodological Index for Non-randomized Studies (MINORS) was adopted to assess the methodological quality of the inclusive studies. MINORS contained 12 items, eight of which were specified for non-comparative studies (Slim et al, 2003;Cullis et al, 2020). The eight items included: study aims, consecutive patient inclusion criteria, prospective pooling of data, endpoint consistent with the study aim, unbiased evaluation of endpoints, follow-up period, loss to follow-up less than 5%, and prospective calculation of the sample size.…”

Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes

“…Nissen fundoplication has traditionally become a popular surgical therapy option for pediatric patients with refractory GERD; however, amongst neurologically impaired children, higher failure rates have often been reported (8). A systematic review by the present study authors (9) has shown that fundoplication improves QoL and reduces esophageal acid exposure in children with and without neurological impairment; however, the benefits seen in the former cohort are less pronounced and longstanding. Patient selection is, therefore, key to improve health outcomes as GERD in the neurologically impaired child represents but a fraction of the foregut neuro‐enteric axis dysfunction.…”

“…These shortcomings are nonetheless ubiquitous amongst many retrospective cohort studies that typify the pediatric surgical literature (47). Similar to our previous study work (9), medical terminology is rarely fully defined in retrospective cohort studies. Neurological impairment is a very broad clinical term, which may encompass a wide spectrum of illness severity, from a specific cognitive deficit, such as hearing loss, to life‐limiting cerebral palsy or a lethal “life limiting” congenital neuromuscular disease.…”

“…Gastrostomy and fundoplication may improve feeding tolerance and GERD (4); however, despite success in many, some will experience wrap failure/migration, persistent retching, and/or delayed gastric emptying (8). Whilst many neurologically impaired children benefit from fundoplication, procedural failure and recurrent GERD are more frequent, where life expectancy is reduced compared with children without disability (9). Redo fundoplication has a high failure rate for these patients and is linked with greater morbidity than the primary operation (8).…”

Gastroesophageal Reflux Disease and Need for Antireflux Surgery in Children with Cystic Fibrosis: A Systematic Review on Incidence, Surgical Complications, and Postoperative Outcomes

“…A recent systematic review of fundoplication in the children with and without neurological impairment showed poorly reported complication rates, ranging from 7 to 37%. 24 The present study ascertained that the ARS-related complication rate in pediatric CF patients was 18%. To note, the earlier and smaller series did not report any complications.…”