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Eur J Pediatr Surg 2016; 26(01): 029-033
DOI: 10.1055/s-0035-1563675
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Is Routine Upper Gastrointestinal Contrast Study Necessary prior to Laparoscopic Gastrostomy Tube Placement in Children?

Shannon N. Acker
1   Department of Surgery, University of Colorado, Aurora, Colorado, United States
,
Becky B. Trinh
1   Department of Surgery, University of Colorado, Aurora, Colorado, United States
,
David A. Partrick
2   Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States
,
Camille L. Stewart
1   Department of Surgery, University of Colorado, Aurora, Colorado, United States
,
Denis D. Bensard
3   Department of Surgery, Denver Health Medical Center, Aurora, Colorado, United States
› Author Affiliations
Further Information

Publication History

02 May 2015

10 July 2015

Publication Date:
18 September 2015 (online)

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Abstract

Introduction Before gastrostomy tube (GT) placement, many pediatric surgeons request that children undergo a preoperative upper gastrointestinal contrast study (UGI) to evaluate for the presence of either gastroesophageal reflux (GER) or intestinal malrotation. We hypothesized that routine UGI is unnecessary before GT placement.

Materials and Methods We performed a retrospective review of 500 consecutive children who had a GT placed in a single children's hospital from 2009 to 2012.

Results There were 403 children who underwent UGI before planned GT placement; 196 of which were placed during the same hospitalization. Only 1/403 (0.25%) diagnosis of malrotation was identified on UGI, and treated with a Ladd procedure at the time of GT placement. There were 154 children who had evidence of reflux on UGI; 97 underwent an antireflux procedure in conjunction with GT placement. An additional 57 children with no evidence of reflux on UGI also underwent a concurrent antireflux procedure. Of these 160 children who underwent concurrent fundoplication, only 3 (2%) had a confirmatory pH probe study performed before GT placement.

Conclusions We found that in children undergoing routine preoperative UGI before GT placement (1) the risk of malrotation is less than 1%; (2) the decision to perform an antireflux procedure weakly correlates with the UGI findings of GER; and (3) one in five patients without radiographic GER still underwent concomitant fundoplication with or without confirmatory pH probe study. We conclude that the practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.

Keywords

upper GI contrast study - gastrostomy tube - malrotation
 

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