Heikenen J B, Werlin S L
Division of Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, and The Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
Dysphagia. 2000 Summer;15(3):167-9. doi: 10.1007/s004550010020.
Clinically symptomatic gastroesophageal reflux may occur after percutaneous endoscopic gastrostomy (PEG). Preoperative evaluation for gastroesophageal reflux does not reliably predict those individuals who will develop reflux unresponsive to medical management after PEG. Esophageal histology at the time of PEG might be used to identify patients at risk for developing intractable gastroesophageal reflux. The study aim was to correlate the clinical outcome after PEG with esophageal histology at the time of PEG insertion. A retrospective review of 68 consecutive children who had an esophageal biopsy obtained at the time of PEG insertion was undertaken. Preoperative evaluation, esophageal histology, and clinical outcomes were compared. Preoperative gastroesophageal reflux was present in 23% of upper gastrointestinal series performed, in 10% of pH probe studies, and in 29% of reflux scans. Histology was normal in 57% of esophageal biopsies obtained at the time of PEG insertion. Symptomatic gastroesophageal reflux requiring antireflux surgery or conversion to gastrojejunostomy developed in 10% of patients after PEG placement. Only one of these patients had esophagitis on biopsy. In conclusion, preoperative esophageal histology does not reliably predict the development of symptomatic gastroesophageal reflux after PEG placement.
经皮内镜下胃造口术（PEG）后可能会出现具有临床症状的胃食管反流。对胃食管反流进行术前评估并不能可靠地预测哪些个体在PEG术后会出现对药物治疗无反应的反流。PEG时的食管组织学检查可用于识别有发生顽固性胃食管反流风险的患者。本研究的目的是将PEG术后的临床结果与PEG插入时的食管组织学进行关联。对68例在PEG插入时进行了食管活检的连续儿童进行了回顾性研究。比较了术前评估、食管组织学和临床结果。在上消化道系列检查中，23%存在术前胃食管反流；在pH值探头研究中，10%存在；在反流扫描中，29%存在。在PEG插入时获取的食管活检中，57%的组织学检查结果正常。PEG置入术后，10%的患者出现了需要抗反流手术或改为胃空肠吻合术的有症状胃食管反流。这些患者中只有1例活检显示有食管炎。总之，术前食管组织学检查不能可靠地预测PEG置入术后有症状胃食管反流的发生。
