title: Utility of Preoperative Upper Gastrointestinal Series in Laparoscopic Gastrostomy Tube Placement.
abstract: BACKGROUND
  An upper gastrointestinal (UGI) series is a standard preoperative test for patients being evaluated for gastrostomy tube placement. We have recently begun to question the value of the radiation-exposing series in patients who tolerate gastric feeds.
  
  
  METHODS
  A retrospective review was conducted in patients who underwent laparoscopic gastrostomy tube placement between 2000 and 2012. Demographics, indication for gastrostomy tube, comorbidities, preoperative imaging, and nutrition were analyzed. Patients with foregut pathology and those who underwent prior gastrointestinal surgery were excluded.
  
  
  RESULTS
  Among 695 patients who underwent laparoscopic gastrostomy tube placement, the most common indications were failure to thrive (53%), neurologic disorder (25%), and dysphagia (12%). A UGI series was obtained for 420 patients (60%). Of these, 96 were found to have abnormalities (reflux, aspiration, anatomic). However, only 2 of these patients (0.3%) had a change in management, with 1 patient undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy for suspected malrotation. In the subset analysis of 256 patients tolerating goal gastric feeds, 161 (63%) had a preoperative UGI series with only 2 patients (1.2%) having a resultant change in operative management: 1 undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy. Of the 275 patients who did not have a preoperative UGI series, 1 patient (0.4%) was found to have malrotation postoperatively after two coins became lodged in the duodenum. This patient subsequently underwent an elective Ladd procedure.
  
  
  CONCLUSIONS
  We found minimal impact of an UGI series during evaluation for gastrostomy alone. These studies may be able to be reserved for those with clear clinical indications.
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Gonzalez
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Brian G A
authors.initials: BG
authors.lastname: Dalton
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Sushanth
authors.initials: S
authors.lastname: Boda
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Pablo
authors.initials: P
authors.lastname: Aguayo
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hendrickson
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: David
authors.initials: D
authors.lastname: Juang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011859:Radiography; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*; D055815:Young Adult