title: Routine gastrostomy tube placement in children: Does preoperative screening upper gastrointestinal contrast study alter the operative plan?
abstract: BACKGROUND
  Upper GI (UGI) studies are routinely ordered to screen for malrotation before routine placement of gastrostomy (G) tubes. However, the usefulness of this study is unknown.
  
  
  METHODS
  A retrospective review of children with surgically placed G-tubes over a 2 year period (2011-2013) was performed. Patients with concomitant fundoplications were excluded.
  
  
  RESULTS
  Three hundred ninety-three patients underwent G-tube placement. Of these, 299 patients (76%) had preoperative UGI, and 11 patients (3.7%) were identified with malrotation on UGI. Five (1.7%) patients underwent a Ladd's procedure. The remaining 6 either had malrotation associated with gastroschisis (n=5) or were lost to follow-up (n=1). Children <1 year did not have different rates of malrotation compared to older children (4.3% vs. 3.2%, p=0.617). Likewise, children with neurologic impairment (NI) had similar rates of malrotation compared to neurologically normal (NN) children (2.6% vs. 3.8%, p=0.692). The only significant difference in malrotation rate was between those with congenital gastrointestinal anomalies (24%) and those without (1.5%) (p<0.001).
  
  
  CONCLUSIONS
  Preoperative screening UGI before routine G-tube placement led to an unexpected diagnosis of malrotation in only 1.7%. Given the added radiation risk associated with an UGI, our data suggest that an UGI is unnecessary prior to routine G-tube placement. A larger prospective study is warranted to validate these results.
authors.affiliation: Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, Texas, 77030.
authors.forename: Paulette I
authors.initials: PI
authors.lastname: Abbas
authors.affiliation: Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, Texas, 77030.
authors.forename: Bindi J
authors.initials: BJ
authors.lastname: Naik-Mathuria
authors.affiliation: Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, Texas, 77030.
authors.forename: Adesola C
authors.initials: AC
authors.lastname: Akinkuotu
authors.affiliation: Texas Children's Hospital and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, Texas, 77030. Electronic address: appimpal@texaschildrens.org.
authors.forename: Ashwin P
authors.initials: AP
authors.lastname: Pimpalwar
mesh_terms: D004065:Digestive System Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D020139:Gastroschisis / Q000000981:diagnostic imaging / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods*
keywords: gastrostomy tube; malrotation; pediatric surgery; preoperative screening; upper gastrointestinal contrast studies