title: Is endoscopic follow-up needed in pediatric patients who undergo surgery for GERD?
abstract: BACKGROUND
  This study evaluated the role of endoscopy in the postoperative management of pediatric patients who undergo fundoplication for GERD.
  
  
  METHODS
  Medical records of 109 otherwise healthy children who underwent operation for GERD from 1979 to 1996 were reviewed. Patients with respiratory symptoms or esophageal stenosis were excluded. All patients underwent endoscopic surveillance with endoscopy being performed in the early (within 1 year) and late (between 1 and 2 years) postoperative periods. Specifically evaluated were the appearance of the wrap and evidence of esophagitis. The risk of a recurrence of esophagitis based on wrap appearance and the presence of clinical symptoms in patients with endoscopic evidence of esophagitis were also evaluated.
  
  
  RESULTS
  At early endoscopy 3 patients with an intact wrap and 8 with a defective wrap had esophagitis (not significant). At late endoscopy, 5 patients with an intact wrap and 17 with a defective wrap had esophagitis (p < 0.05).
  
  
  CONCLUSIONS
  An intact wrap does not prevent recurrence of GERD. Such an occurrence is even more likely when endoscopy demonstrates a defective wrap. For all patients who have undergone fundoplication, endoscopic evaluation at 1 to 2 years is recommended to detect esophagitis in the absence of symptoms so treatment can be initiated before symptoms occur.
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Strada del nobile 23, 10131 Turin, Italy.
authors.forename: Nino
authors.initials: N
authors.lastname: Guarino
authors.forename: Emanuela
authors.initials: E
authors.lastname: Ceriati
authors.forename: Antonio
authors.initials: A
authors.lastname: Zaccara
authors.forename: Edoardo
authors.initials: E
authors.lastname: La Sala
authors.forename: Francesco
authors.initials: F
authors.lastname: De Peppo
authors.forename: Luigi
authors.initials: L
authors.lastname: Dall'Oglio
authors.forename: Massimo
authors.initials: M
authors.lastname: Rivosecchi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000175:diagnosis; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods*; D012008:Recurrence