title: The development of gastroesophageal reflux after percutaneous endoscopic gastrostomy.
abstract: The relationship between percutaneous endoscopic gastrostomy (PEG) and subsequent development of gastroesophageal reflux (GER) is complex and not well understood. The authors retrospectively reviewed 82 children over a 5-year period who underwent PEG tube (n = 64) or PEG button (n = 18) placement. Children were evaluated preoperatively for clinical evidence of GER (C-GER) or radiographic GER (R-GER) with upper gastrointestinal contrast study or Tc99m gastric scinitiscan. Seventy-five patients were evaluated for clinical evidence of postoperative GER by direct family contact. Eleven of 39 (28%) patients with no GER preoperatively developed GER postoperatively, eight (20%) of whom required Nissen fundoplication (NF) or gastrojejunostomy (GJ) tube. Ten of 19 (53%) with preoperative C-GER but no R-GER continued to have GER after PEG, but only three required NF or GJ. Only one of nine children who had R-GER only developed clinical GER after PEG placement. Of the eight children with both C-GER and R-GER, only two (25%) required NF or GJ and two (25%) had no postoperative GER. The authors conclude that PEG tubes are useful in infants and children and are associated with a relatively low incidence of postoperative GER. If C-GER is absent, a PEG is a reasonable procedure to consider even in the presence of R-GER.
authors.affiliation: Department of Surgery, Indiana University, JW Riley Hospital for Children, Indianapolis 46202, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Isch
authors.forename: F J
authors.initials: FJ
authors.lastname: Rescorla
authors.forename: L R
authors.initials: LR
authors.lastname: Scherer
authors.forename: K W
authors.initials: KW
authors.lastname: West
authors.forename: J L
authors.initials: JL
authors.lastname: Grosfeld
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology*; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies