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
