Routine gastrostomy tube placement in children: Does preoperative screening upper gastrointestinal contrast study alter the operative plan?

Paulette I. Abbas, Bindi J. Naik-Mathuria, Adesola C. Akinkuotu, Ashwin P. Pimpalwar

Research output: Contribution to journalArticlepeer-review

Abstract

Background Upper GI (UGI) studies are routinely ordered to screen for malrotation before routine placement of gastrostomy (G) tubes. However, the usefulness of this study is unknown. Methods A retrospective review of children with surgically placed G-tubes over a 2 year period (2011-2013) was performed. Patients with concomitant fundoplications were excluded. Results Three hundred ninety-three patients underwent G-tube placement. Of these, 299 patients (76%) had preoperative UGI, and 11 patients (3.7%) were identified with malrotation on UGI. Five (1.7%) patients underwent a Ladd's procedure. The remaining 6 either had malrotation associated with gastroschisis (n = 5) or were lost to follow-up (n = 1). Children < 1 year did not have different rates of malrotation compared to older children (4.3% vs. 3.2%, p = 0.617). Likewise, children with neurologic impairment (NI) had similar rates of malrotation compared to neurologically normal (NN) children (2.6% vs. 3.8%, p = 0.692). The only significant difference in malrotation rate was between those with congenital gastrointestinal anomalies (24%) and those without (1.5%) (p < 0.001). Conclusion Preoperative screening UGI before routine G-tube placement led to an unexpected diagnosis of malrotation in only 1.7%. Given the added radiation risk associated with an UGI, our data suggest that an UGI is unnecessary prior to routine G-tube placement. A larger prospective study is warranted to validate these results.

Original languageEnglish (US)
Pages (from-to)715-717
Number of pages3
JournalJournal of Pediatric Surgery
Volume50
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Keywords

  • gastrostomy tube
  • malrotation
  • pediatric surgery
  • preoperative screening
  • upper gastrointestinal contrast studies

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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