title: Does laparoscopy-aided gastrostomy placement improve or worsen gastroesophageal reflux in patients with neurological impairment?
abstract: OBJECTIVE
  The purpose of this study was to retrospectively investigate whether laparoscopy-aided gastrostomy placement (LGP) improved or worsened gastroesophageal reflux (GER) in neurological impairment (NI) patients.
  
  
  METHODS
  Subjects included 26 NI patients nourished via nasogastric tubes (age, 1-17years; median, 6years). They were divided into groups based on the percentage of time with an esophageal pH <4.0 (reflux index: RI) before LGP: Group 1 (GI, n=13), RI <5.0%; Group II (GH, n=13), RI ≥5.0%. Acid/nonacid reflux episodes (RE) were evaluated using combined pH-multichannel intraluminal impedance (pH-MII) monitoring, and gastric emptying was measured with the C breath test before and after LGP.
  
  
  RESULTS
  RI and number of RE evaluated with pH analyses and number of total/acid distal and proximal bolus RE with pH-MH increased significantly in GI. RI and acid clearance time with pH analyses and number of total bolus RE with pH-MII decreased significantly in GH. Gastric emptying parameters did not change significantly in GI, whereas the half-gastric emptying time and gastric emptying coefficient improved significantly in GH.
  
  
  CONCLUSIONS
  LGP reduces GER in NI patients with pathological GER by improving gastric emptying, although it has a paradoxical influence on those without pathological GER.
authors.affiliation: Department of Pediatric Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. Electronic address: kawahara.hisayoshi@gmail.com.
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Kawahara
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tazuke
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Soh
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoneda
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuzawa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gastric emptying; Gastroesophageal reflux; Gastrostomy; pH-multichannel intraluminal impedance