Percutaneous endoscopic gastrostomy (PEG) does not worsen vomiting in children
- 387 Downloads
We aimed to evaluate the rate and examine potential predictors of subsequent anti-reflux procedures in a population undergoing percutaneous endoscopic gastrostomy (PEG) insertion.
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.
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.
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.
KeywordsPercutaneous endoscopic gastrostomy Vomiting Anti-reflux surgery Gastro-esophageal reflux Fundoplication
The authors declare no conflict of interest. Due to the retrospective nature of the study ethical approval was not sought on the basis of local hospital guidelines. No sources of funding were utilized in the carrying out of this research.
- 6.Toporowska-Kowalska E, Gebora-Kowalska B, Fendler W, Popinska K, Szlagatys-Sidorkiewicz A, Grzybowska-Chlebowczyk U, Wiernicka A, Borkowska A, Sibilska M, Wiecek S, Hapyn E, Kierkus J (2013) Diagnosis of gastroesophageal reflux and anti-reflux procedures among Polish children with gastrostomies: a 10-year nationwide analysis. Eur J Clin Nutr 67(11):1169–1174. doi: 10.1038/ejcn.2013.164 CrossRefPubMedCentralPubMedGoogle Scholar
- 10.King M, Barnhart DC, O’Gorman M, Downey EC, Jackson D, Mundorff M, Holubkov R, Feola P, Srivastava R (2014) Effect of gastrojejunal feedings on visits and costs in children with neurologic impairment. J Pediatr Gastroenterol Nutr 58(4):518–524. doi: 10.1097/MPG.0000000000000227 CrossRefPubMedGoogle Scholar
- 23.Toporowska-Kowalska E, Gebora-Kowalska B, Jablonski J, Fendler W, Wasowska-Krolikowska K (2011) Influence of percutaneous endoscopic gastrostomy on gastro-oesophageal reflux evaluated by multiple intraluminal impedance in children with neurological impairment. Dev Med Child Neurol 53(10):938–943. doi: 10.1111/j.1469-8749.2011.04031.x CrossRefPubMedGoogle Scholar