title: Children with neurological disorders do not always need fundoplication concomitant with percutaneous endoscopic gastrostomy.
abstract: Whether antireflux surgery should be routinely performed at the time of gastrostomy in children with neurological disorders is debatable because of the risk of gastroesophageal reflux. Some argue that these children should be screened for occult gastroesophageal reflux as this will determine the need for fundoplication. This study retrospectively examines outcome in 29 children with neurological disorders who underwent percutaneous endoscopic gastrostomy (PEG) without concomitant fundoplication. Children were included if they had no clinical evidence of severe gastroesophageal reflux before PEG insertion. The median age of children at PEG insertion was 5.6 years (range 1.1 to 18.0). The children were followed for a median of 2.6 years (range 0.4 to 4.9). Insertion of PEG was technically impossible in two children; and an asymptomatic gastrocolic fistula in another child led to subsequent tube removal. Fourteen of the 26 remaining children developed symptomatic gastroesophageal reflux after PEG; five of these showed no reflux on pH monitoring prePEG. Control of symptoms was achieved by medical intervention in 12, but two required fundoplication. Our findings indicate that in the child with neurological disabilities without symptoms indicating severe gastroesophageal reflux, fundoplication is unlikely to be necessary as a consequence of PEG insertion. We conclude that routine investigation for gastroesophageal reflux in the child without severe vomiting can be avoided and the number of antireflux procedures reduced.
authors.affiliation: University of Leeds, The General Infirmary at Leeds, Neonatal Unit, UK. 100677.2423@compuserve.com
authors.forename: J W
authors.initials: JW
authors.lastname: Puntis
authors.forename: R
authors.initials: R
authors.lastname: Thwaites
authors.forename: G
authors.initials: G
authors.lastname: Abel
authors.forename: M D
authors.initials: MD
authors.lastname: Stringer
mesh_terms: D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000209:etiology; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome