Is Routine Upper Gastrointestinal Contrast Study Necessary prior to Laparoscopic Gastrostomy Tube Placement in Children?

Abstract

We found that in children undergoing routine preoperative UGI before GT placement (1) the risk of malrotation is less than 1%; (2) the decision to perform an antireflux procedure weakly correlates with the UGI findings of GER; and (3) one in five patients without radiographic GER still underwent concomitant fundoplication with or without confirmatory pH probe study. We conclude that the practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

“…3,8,19,20 Two additional studies explored the relationship between esophagitis found on esophageal biopsies and presence of gastroesophageal reflux on upper GI findings prior to GT placement, and the eventual risk of having a subsequent fundoplication procedure; neither the presence of esophagitis nor the findings of reflux via fluoroscopy seemed to correlate well with the need for fundoplication. 15,21 …”

“…Prior fundoplication literature has proposed that younger age, the presence of a neurologic comorbidity, history of dysphagia with resultant aspiration, as seen on videofluorscopic swallow studies, may be associated with an increased need for potential fundoplication, whereas other authors have proposed that preoperative abnormal pH probe studies may have a higher likelihood of predicting patients who may go on to need fundoplication (3,8,19,20). Two additional studies explored the relationship between esophagitis found on esophageal biopsies and presence of gastroesophageal reflux on upper GI findings before GT tube placement, and the eventual risk of having a subsequent fundoplication procedure; neither the presence of esophagitis nor the findings of reflux via fluoroscopy seemed to correlate well with the need for fundoplication (15,21).…”