CHU Lille, University of Lille, Reference Center for Congenital and Malformative Esophageal Diseases (CRACMO), Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Jeanne de Flandre, Lille University Children's Hospital, Lille, France.
CHU Lille, University of Lille, Reference Center for Congenital and Malformative Esophageal Diseases (CRACMO), Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Jeanne de Flandre, Lille University Children's Hospital, Lille, France.
J Pediatr. 2018 Jun;197:116-120. doi: 10.1016/j.jpeds.2018.02.003. Epub 2018 Apr 11.
To determine if gastroesophageal reflux disease (GERD) is present at long-term follow-up after percutaneous endoscopic gastrostomy (PEG), and to identify factors associated with the occurrence or aggravation of GERD after PEG placement.
This prospective, observational study was conducted in our single tertiary center over a 13-year period (gastrostomy performed from 1990 to 2003 and follow-up to 2015). Every child who underwent PEG in our center (N = 368) from 1990 to 2003 was eligible. GERD was defined by clinical manifestations requiring antisecretory or prokinetic treatment, occurrence of a GERD-related complication, or the need for antireflux surgery. Outcomes among patients without antireflux surgery were also assessed. Multivariate analysis was used to identify factors aggravating GERD after PEG placement.
A total 326 patients (89%; 56% with a neurologic impairment) were studied with a median follow-up after 3.5 years (range, 2.0-13.5 years). After PEG placement, GERD appeared in 11% of patients and was aggravated in 25% of patients with preexisting GERD. Factors associated with GERD worsening after PEG placement were neurologic impairment and preexisting GERD. Only 53 patients (16%) required antireflux surgery, among whom 22 required surgery in the year after PEG. Neurologic impairment was the only factor significantly associated with the need for antireflux surgery.
GERD predominantly remains clinically controlled after PEG placement. Routine antireflux surgery at the time of PEG placement is not justified.
确定经皮内镜胃造口术（PEG）后长期随访时是否存在胃食管反流病（GERD），并确定与 PEG 放置后 GERD 发生或加重相关的因素。
这是一项前瞻性、观察性研究，在我们的单中心进行，历时 13 年（1990 年至 2003 年进行胃造口术，随访至 2015 年）。1990 年至 2003 年期间在我们中心接受 PEG 的每个患儿（N=368）均符合入选条件。GERD 通过需要抗分泌或促动力治疗的临床表现、GERD 相关并发症的发生或需要抗反流手术来定义。还评估了未行抗反流手术的患者的结局。使用多变量分析来确定 PEG 放置后加重 GERD 的因素。
共有 326 名患者（89%；56%存在神经功能障碍）进行了研究，中位随访时间为 3.5 年（范围，2.0-13.5 年）。PEG 放置后，11%的患者出现 GERD，25%存在原有 GERD 的患者 GERD 加重。与 PEG 放置后 GERD 恶化相关的因素是神经功能障碍和原有 GERD。仅有 53 名患者（16%）需要抗反流手术，其中 22 名在 PEG 后 1 年内需要手术。神经功能障碍是唯一与抗反流手术需要显著相关的因素。
PEG 放置后 GERD 主要保持临床控制。PEG 放置时常规行抗反流手术没有依据。
