Gastroesophageal Reflux and Nissen Fundoplication Following Percutaneous Endoscopic Gastrostomy in Children

Abstract

Percutaneous endoscopic gastrostomy is a safe and effective technique for long-term nutritional support in children. Abnormal gastroesophageal reflux is common. Normal findings in an esophageal pH study before percutaneous endoscopic gastrostomy may be predictive of a favorable outcome with respect to gastroesophageal reflux. This is in contrast to patients with abnormal results in pH studies before percutaneous endoscopic gastrostomy of whom a relatively large percentage may later require fundoplication. Improved nutritional status after percutaneous endoscopic gastrostomy does not appear to have an impact on the severity of gastroesophageal reflux.

A.S.P.E.N. Enteral Nutrition Practice Recommendations

“…49 An earlier study by PayneJames looked at contaminated formula and retrograde movement of bacteria in tubing sets with no drip chamber, a drip chamber, and a drip chamber plus an anti-reflux valve. 46 Results showed no bacterial contamination of the EN formula when tubing with a drip chamber was used. 46 Two studies done in the Netherlands in intensive care unit (ICU) patients looked at bacterial contamination of enteral administration sets and found them to be unacceptably contaminated after a 24-hour hang time.…”

“…46 Results showed no bacterial contamination of the EN formula when tubing with a drip chamber was used. 46 Two studies done in the Netherlands in intensive care unit (ICU) patients looked at bacterial contamination of enteral administration sets and found them to be unacceptably contaminated after a 24-hour hang time. 48,60 These studies suggested that retrograde migration of bacteria from the stomach and lungs are a problem.…”

“…Two studies on this issue found that contamination did not occur when the tubing had a drip chamber. 46,47 If the retrograde colonization load is high or is from some particularly bad pathogens, it can be problematic, especially if the patient is already sick. While food in general is not sterile, it goes directly to the body's defense mechanisms (hydrocholoric acid and bile) which kill off many organisms in healthy individuals.…”

Percutaneous Endoscopic Gastrostomy in Pediatric Patients

“…In children without s y m p t o m s o f r e f l u x o r w i t h m i l d r e f l u x responding well to medical treatment, an endoscopic percutaneous approach may be used. There is no role for a prophylactic antireflux procedure (Sulaeman et al, 1998, Isch et al, 1997. The choice between a gastrostomy with or without an anti-reflux procedure has to be carefully evaluated because the failure rate and the incidence of major complications are high in neurologically impaired children undergoing anti-reflux procedure (Borgstein et al, 1994).…”

“…The improvement of physical growth coupled with improvement in the general health and the family quality of life (Stevenson, 2005). Direct aspiration of orally ingested material and saliva may be a reason for recommending PEG tube feeding (Brant et al, 1999, Sulaeman et al, 1998. But gastroesophageal reflux is also thought to contribute to aspiration indirectly (Morton et al, 1999).…”