How necessary is upper gastrointestinal study with contrast pre-gastrostomy for patients with feeding difficulties secondary to neurological disorders
V Caferov, Ş Emre, R Özcan, A Karagöz, G Topuzlu Tekant
Istanbul University Cerrahpasa Medical Faculty Department of Pediatric Surgery
Purpose: To investigate the necessity of pre-operative upper gastrointestinal
contrast study in patients with feeding difficulties due to neurological
disorders who are planned to undergo gastrostomy opening.Cases
and Method: Case records of patients with neurological
disorders that underwent gastrostomy opening between the years 2005-2015 were
evaluated retrospectively. The routine practice in our clinic is as follows;
Pre- operative upper gi contrast study is performed, if an anotomical disorder
such as gastroesophageal reflux and/or hiatal hernia should be detected,
(GER-AD) Stamm Gastrostomy and Nissen Fundoplication (SG-NF) is undertaken
according to the patient’s life expectancy (Group 1). Percutaneus endoscopic
gastrostomy prodecure (PEG) is undertaken if the life expectancy is minimal
and/or there is no evidence of anatomical dysfunction (Group 2). The analysed
variants were age, gender, indication for gastrostomy opening, necessity of
fundoplication, early and late post-op complications.Results: A total of 71 patients had gastrostomies opened with an underlying
etiology of neurological basis. Of these patients 42 were female and 29 were
male. Indications for the procedure were; growth retardation (n:67), aspiration
episodes during feeding (n:51) and swallowing difficulties (n:10). Median age
was 4,6 ( range 1 mo- 16 yr). Hiatal hernia was detected in 2 of the patients
in Group1 (n:39, %55), no event took place during their procedures. Pre-operative
baloon dilatation was performed in 2 patients that had stricture formation
secondary to GER. In Group 1, post-op complication occured in only 1 patient,
which was evisceration. Neurological malignity was present in 6 cases from
Group 2 (n:32,%45) . Among these, 2 cases underwent PEG opening despite the
fact that they were diagnosed with GER. Post-op complication occured in 5
cases. Stamm gastrostomy was perdormed in 2 cases secondary to bleeding. 3
cases developed early post-op abdominal hematoma, of which 2 were followed-up
and 1 was drained percutaneously. 2 cases developed GER that was clinically
presented later on. Stamm gastrostomy was performed in one patient one year
after the first PEG procedure.Conclusion: Upper gastrointestinal contrast study is of value in patients with
neurological disorders who are planned for gastrostomy opennings in means of
detecting GER-AD and determining the
surgical method according to the life expectancy of the patients. Percutaneous
endoscopic gastrostomy is an option in patients that do not show GER-AD in
their contrast studies or the ones that have a minimal life expectancy. While
PEG is generally considered as a minimally invasive procedure, it has a high
complication rates which could be well handled if the procedure is undertaken
at a surgical clinic under general anesthesia. Cases that show aspiration or
recurrent upper respiratory tract infection after PEG procedure shoud be
investigated for GER.
Keywords: