title: Is Routine Upper Gastrointestinal Contrast Study Necessary prior to Laparoscopic Gastrostomy Tube Placement in Children?
abstract: BACKGROUND
  Before gastrostomy tube (GT) placement, many pediatric surgeons request that children undergo a preoperative upper gastrointestinal contrast study (UGI) to evaluate for the presence of either gastroesophageal reflux (GER) or intestinal malrotation. We hypothesized that routine UGI is unnecessary before GT placement.
  
  
  METHODS
  We performed a retrospective review of 500 consecutive children who had a GT placed in a single children's hospital from 2009 to 2012.
  
  
  RESULTS
  There were 403 children who underwent UGI before planned GT placement; 196 of which were placed during the same hospitalization. Only 1/403 (0.25%) diagnosis of malrotation was identified on UGI, and treated with a Ladd procedure at the time of GT placement. There were 154 children who had evidence of reflux on UGI; 97 underwent an antireflux procedure in conjunction with GT placement. An additional 57 children with no evidence of reflux on UGI also underwent a concurrent antireflux procedure. Of these 160 children who underwent concurrent fundoplication, only 3 (2%) had a confirmatory pH probe study performed before GT placement.
  
  
  CONCLUSIONS
  We found that in children undergoing routine preoperative UGI before GT placement (1) the risk of malrotation is less than 1%; (2) the decision to perform an antireflux procedure weakly correlates with the UGI findings of GER; and (3) one in five patients without radiographic GER still underwent concomitant fundoplication with or without confirmatory pH probe study. We conclude that the practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.
authors.affiliation: Department of Surgery, University of Colorado, Aurora, Colorado, United States.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Surgery, University of Colorado, Aurora, Colorado, United States.
authors.forename: Becky B
authors.initials: BB
authors.lastname: Trinh
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.affiliation: Department of Surgery, University of Colorado, Aurora, Colorado, United States.
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Department of Surgery, Denver Health Medical Center, Aurora, Colorado, United States.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D002648:Child; D003287:Contrast Media; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000601:surgery; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging* / Q000601:surgery; D007441:Intubation, Gastrointestinal / Q000379:methods; D010535:Laparoscopy; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media