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Long-term outcome and efficiency of symptom-selective approach to assess gastroesophageal reflux prior to gastrostomy in neurologically impaired children

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Abstract

Purpose

To evaluate the necessity of preoperative screening for gastroesophageal reflux (GER) prior to gastrostomy in neurologically impaired children.

Methods

Medical records of neurologically impaired children, who have undergone laparoscopic gastrostomy between January, 2004 and June, 2018, were retrospectively reviewed. Before the year of 2014, all patients who required gastrostomy had been routinely screened for GER pre-operatively, but after the year of 2014, only the ones with GER-related symptoms were tested. The characteristics and outcomes of Routine Screening (RS) and Selective Screening (SS) periods were compared.

Results

There were 55 and 54 patients in the RS and SS periods, respectively. Demographics, primary pathologies, and mean follow-up durations (> 2 years) were similar. The rate of GER screening was significantly lower in the SS period (29.6% vs. 63.6%). The rate of Laparoscopic Nissen Fundoplication (LNF) combined with gastrostomy was significantly lower in the SS period (14.8% vs. 38.2%). During follow-up, the rates of new-onset GER symptoms (13% vs. 11.7%) and LNF requirement later on (6.5% vs. 8.8%) were statistically similar between the two periods.

Conclusion

Routine screening for GER is not necessary prior to gastrostomy in neurologically impaired children. Symptom-selective screening algorithm is safe and efficient in the long term.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Ege University Faculty of Medicine, 35100, Bornova, Izmir, Turkey

    Hilmican Ulman, Zafer Dokumcu, Vusale Elekberova, Ulgen Celtik, Emre Divarci, Coskun Ozcan & Ata Erdener

Authors
  1. Hilmican Ulman
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  2. Zafer Dokumcu
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  3. Vusale Elekberova
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  4. Ulgen Celtik
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  6. Coskun Ozcan
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  7. Ata Erdener
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Contributions

Study conception and design: Zafer Dokumcu, Ata Erdener, Coskun Ozcan; Data acquisiton: Hilmican Ulman, Vusale Elekberova, Ulgen Celtik, Emre Divarci; Analysis and data interpretation: Hilmican Ulman, Zafer Dokumcu; Drafting of the manuscript: Hilmican Ulman, Zafer Dokumcu, Vusale Elekberova; Critical revision: Zafer Dokumcu, Ata Erdener, Coskun Ozcan.

Corresponding author

Correspondence to Zafer Dokumcu.

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Conflict of interest

Author Hilmican Ulman, declares that he has no conflict of interest. Author Zafer Dokumcu, declares that he has no conflict of interest. Author Vusale Elekberova, declares that she has no conflict of interest. Author Ulgen Celtik, declares that she has no conflict of interest. Author Emre Divarci, declares that he has no conflict of interest. Author Coskun Ozcan, declares that he has no conflict of interest. Author Ata Erdener, declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was performed with the approval granted by Institutional Medical Research Ethics Committee (19-6.1T/63).

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Informed consent was obtained from all individual participants included in the study.

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Ulman, H., Dokumcu, Z., Elekberova, V. et al. Long-term outcome and efficiency of symptom-selective approach to assess gastroesophageal reflux prior to gastrostomy in neurologically impaired children. Pediatr Surg Int 37, 903–909 (2021). https://doi.org/10.1007/s00383-021-04891-5

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  • DOI: https://doi.org/10.1007/s00383-021-04891-5

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