Oral Presentation - 21
How necessary is upper gastrointestinal study with contrast pre-gastrostomy for patients with feeding difficulties secondary to neurological disorders
Vüsal Caferov, Şenol Emre, Rahşan Özcan, Ayşe Karagöz, Gonca 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.