Is endoscopic follow-up needed in pediatric patients who undergo surgery for GERD?
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.
Guarino
Nino
N
Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Strada del nobile 23, 10131 Turin, Italy.
Ceriati
Emanuela
E
Zaccara
Antonio
A
La Sala
Edoardo
E
De Peppo
Francesco
F
Dall'Oglio
Luigi
L
Rivosecchi
Massimo
M
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