title: Percutaneous endoscopic gastrostomy (PEG) does not worsen vomiting in children.
abstract: OBJECTIVE
  We aimed to evaluate the rate and examine potential predictors of subsequent anti-reflux procedures in a population undergoing percutaneous endoscopic gastrostomy (PEG) insertion.
  
  
  METHODS
  We retrospectively reviewed the pre- and post-operative clinical course of patients undergoing PEG insertion over a 10-year period with respect to indication, underlying co-morbidity, and GER investigation and management.
  
  
  RESULTS
  We reviewed data on 170 patients. Neurological disability (e.g., cerebral palsy) was the most common underlying condition in those undergoing PEG insertion (n = 104) followed by cystic fibrosis (n = 29). Oropharyngeal dysphagia and failure to thrive were the commonest indications for PEG. Eight patients (4.7%) reported increased frequency of vomiting after PEG, 6 (75%) of whom had a pre-operative diagnosis of GER. Two (25%) patients from this sub-group subsequently required anti-reflux surgery. Patient's with neurological disease were not at increased risk of new-onset GER or increased vomiting following PEG insertion compared to those with non-neurological conditions (p = 0.259). In total, 8 (4.7%) and 7 (4.1%) patients underwent fundoplication and gastrojejunal tube insertion, respectively.
  
  
  CONCLUSIONS
  PEG insertion does not appear to induce symptomatic gastro-oesophageal reflux in the majority of children, suggesting that in the majority of cases, a concurrent anti-reflux procedure is unnecessary. Parents should be counseled accordingly.
authors.affiliation: Department of Pediatric Surgery, Temple Street Children's University Hospital, Dublin 1, Ireland, thakur.madhavi@gmail.com.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Kakade
authors.forename: David
authors.initials: D
authors.lastname: Coyle
authors.forename: Dermot T
authors.initials: DT
authors.lastname: McDowell
authors.forename: John
authors.initials: J
authors.lastname: Gillick
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014839:Vomiting / Q000453:epidemiology*; D055815:Young Adult