title: Endoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery indicated?
abstract: OBJECTIVE
  Previously, we performed concomitant antireflux surgery in patients with abnormal pH study undergoing gastrostomy. This increased complications without always alleviating the troublesome symptom of vomiting. In contrast, vomiting with normal preoperative pH study generally disappeared after gastrostomy placement. Therefore, we changed policy to perform only gastrostomy, regardless of pH study results. Subsequent antireflux surgery is performed only as necessary. We report here our results.
  
  
  METHODS
  We retrospectively reviewed patients undergoing gastrostomy from April 1997 to January 2004. For patients with abnormal preoperative pH studies, detailed data were recorded including medical history, indication for gastrostomy, operative technique, symptoms of gastroesophageal reflux (GER), and use of antireflux medication. Symptomatic GER postgastrostomy was managed pharmacotherapeutically. If this proved inadequate, patients underwent antireflux surgery.
  
  
  RESULTS
  Twenty-eight patients with abnormal pregastrostomy pH study entered the study. Median age was 3 years and 2 months. Seventy-five percent were neurologically impaired. Indication for gastrostomy was inadequate oral nutrition in 26 of 28 patients. Only 3 of 28 patients were asymptomatic for GER. Of the 25 symptomatic patients 19 improved postgastrostomy (6 did not). Antireflux surgery ultimately proved indicated in 2 patients (7% [2/28]). The asymptomatic patients remained asymptomatic.
  
  
  CONCLUSIONS
  For patients with abnormal pH study presenting primarily for gastrostomy placement, concomitant antireflux surgery is not indicated.
authors.affiliation: Department of Pediatric Surgery (KE.04.140.5), Wilhelmina Children's Hospital, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands.
authors.forename: Guin J P
authors.initials: GJ
authors.lastname: Wilson
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.forename: Nikolaas M A
authors.initials: NM
authors.lastname: Bax
mesh_terms: D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D000897:Anti-Ulcer Agents