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The relationship between percutaneous endoscopic gastrostomy and gastro-oesophageal reflux disease in children: a systematic review

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Abstract

Background

The relationship between percutaneous endoscopic gastrostomy (PEG) insertion and gastro-oesophageal reflux disease (GERD) is widely disputed in the current literature. The aim of this systematic review is to examine the available evidence documenting the association between PEG and GERD.

Methods

The following databases were searched: MEDLINE (1950 to week 2, January 2011), PubMed, ISI Web of Knowledge (1898 to week 2, January, 2011), EMBASE (1980 to week 2, January 2011) and The Cochrane Central Register of Controlled Trials (CENTRAL) using the terms “gastroesophageal reflux”, “gastroesophageal disease”, “GERD”, “GERD”, “GER”, “GER” and “percutaneous endoscopic gastrostomy”, “PEG”, “gastrostomy”. In addition, the reference lists of all included studies were reviewed for relevant citations. Studies examining children pre and post insertion of PEG for GERD and written in English language were included. Data extraction was performed by two authors, and the methodology and statistical analysis of each study were assessed.

Results

Eight studies were included in this systematic review. Two reported increased incidence of GERD after PEG. However, neither was of high methodological quality. The remaining six reported no change or decreased GERD. Nonetheless, few demonstrated rigorous methodology.

Conclusions

The current evidence examining the effect of PEG insertion on GERD has been inconsistent and is not of high quality and therefore is unconvincing, preventing a definitive conclusion. Overall, the available literature on this topic does not demonstrate a causal effect of PEG insertion on GERD.

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Disclosure

Authors Louise Noble, A Mark Dalzell and Wael El-Matary have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

    Louise J. Noble & A. Mark Dalzell

  2. Section of Pediatric Gastroenterology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada

    Wael El-Matary

  3. Health Sciences Centre, AE408 Children’s Hospital, 840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada

    Wael El-Matary

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  1. Louise J. Noble
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  2. A. Mark Dalzell
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  3. Wael El-Matary
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Correspondence to Wael El-Matary.

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Noble, L.J., Dalzell, A.M. & El-Matary, W. The relationship between percutaneous endoscopic gastrostomy and gastro-oesophageal reflux disease in children: a systematic review. Surg Endosc 26, 2504–2512 (2012). https://doi.org/10.1007/s00464-012-2221-8

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