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Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement

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Abstract

Purpose

Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment.

Methods

Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database. Children with a diagnosis of cerebral palsy or a degenerative neurologic disease were identified and compared to children without these diagnoses. The incidence of delayed fundoplication or conversion to GJ were compared utilizing Kaplan–Meier and Cox proportional hazards regression analyses.

Results

A total of 14,965 children underwent GT placement, of which 3712 (24.8%) had a diagnosis of neurologic impairment. The rate of concomitant fundoplication was significantly higher among children with a diagnosis of neurologic impairment as compared to those without (9.3% vs 6.4%, p < 0.001). While children with neurologic impairment had a significantly higher rate of fundoplication or GJ conversion at 5 years compared to children without (12.6% [95% confidence interval (CI): 11.4%–13.8%] vs 8.6% [95% CI 8.0%–9.2%], p < 0.001), the overall incidence remained low.

Conclusion

Although children with neurologic impairment have a higher rate of requiring an antireflux procedure or GJ conversion than other children, the overall rate remains less than 15%. Fundoplication should not be utilized in children without clinical reflux on the basis of neurologic impairment alone.

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Funding

This work was supported by internal departmental funds.

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Authors and Affiliations

  1. Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA

    Michael D. Williams, Nicholas Skertich, Gwyneth A. Sullivan, Kelly Harmon, Mary Beth Madonna, Srikumar Pillai, Ami N. Shah & Brian C. Gulack

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  1. Michael D. Williams
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  2. Nicholas Skertich
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  3. Gwyneth A. Sullivan
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  4. Kelly Harmon
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  5. Mary Beth Madonna
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  6. Srikumar Pillai
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  8. Brian C. Gulack
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Contributions

MW contributed to study design, data collection and analysis, drafted the manuscript, and critically reviewed and revised the manuscript. NS and GS contributed to study design, and critically reviewed and revised the manuscript. KH collected data and performed analysis, and critically revised the manuscript. MM, SP, and AS critically reviewed and revised the manuscript for important intellectual content. BG conceptualized and designed the study, supervised data collection, and critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Brian C. Gulack.

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Williams, M.D., Skertich, N., Sullivan, G.A. et al. Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement. Pediatr Surg Int 39, 122 (2023). https://doi.org/10.1007/s00383-023-05398-x

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