title: Fundoplication and gastrostomy versus percutaneous gastrojejunostomy for gastroesophageal reflux in children with neurologic impairment: A systematic review and meta-analysis.
abstract: BACKGROUND
  Children with neurologic impairment often fail medical management of gastroesophageal reflux and proceed to fundoplication and gastrostomy (FG) or percutaneous gastrojejunostomy (GJ). Current guidelines do not recommend one treatment over the other, and there is ongoing uncertainty regarding clinical management.
  
  
  METHODS
  We conducted a structured search of Medline, Embase, trial registries, and the gray literature. We included studies that compared outcomes for FG and GJ in children with neurologic impairment.
  
  
  RESULTS
  We identified 556 children from three retrospective studies who underwent FG (n=431) or GJ (n=125). There were no differences in rates of pneumonia (17% vs 19%, p=0.74) or mortality (13% vs 14%, p=0.76). Few deaths were due to procedural complications (1%) or reflux (2%). There was a trend towards more major complications with FG (29%) compared to GJ (12%) (risk ratio=1.70, 0.85-3.41, p=0.14). Minor complications were more common with GJ (70%) than FG (45%), but this difference was also not statistically significant (risk ratio=0.38, 0.05-3.07, p=0.36). No studies reported quality of life using validated measures.
  
  
  CONCLUSIONS
  The quality of the evidence for outcomes of FG versus GJ is very low. Large comparative studies are needed to determine which approach is associated with the best quality-of-life outcomes.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Clinician Investigator Program, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Western University, London, Ontario, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.affiliation: CanChild Center for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Rosenbaum
authors.affiliation: Division of Pediatric Surgery, Western University, London, Ontario, Canada.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Jones
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: waltonj@mcmaster.ca.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Walton
mesh_terms: D002648:Child; D018662:Fundoplication / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications*; D011788:Quality of Life
keywords: Children; Fundoplication; Gastroesophageal reflux; Gastrojejunostomy; Neurological impairment