Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement
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In brief
In brief
This national database study of nearly 15,000 children found that only 12.6% of neurologically impaired patients required antireflux procedures within 5 years of gastrostomy placement. The findings challenge routine prophylactic fundoplication in this population, suggesting procedures should be reserved for patients with documented clinical reflux rather than performed based on neurologic diagnosis alone.
Written by the GCMD Library team from the article.
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.