Isch J A, Rescorla F J, Scherer L R, West K W, Grosfeld J L
Department of Surgery, Indiana University, JW Riley Hospital for Children, Indianapolis 46202, USA.
J Pediatr Surg. 1997 Feb;32(2):321-2; discussion 322-3. doi: 10.1016/s0022-3468(97)90202-5.
The relationship between percutaneous endoscopic gastrostomy (PEG) and subsequent development of gastroesophageal reflux (GER) is complex and not well understood. The authors retrospectively reviewed 82 children over a 5-year period who underwent PEG tube (n = 64) or PEG button (n = 18) placement. Children were evaluated preoperatively for clinical evidence of GER (C-GER) or radiographic GER (R-GER) with upper gastrointestinal contrast study or Tc99m gastric scinitiscan. Seventy-five patients were evaluated for clinical evidence of postoperative GER by direct family contact. Eleven of 39 (28%) patients with no GER preoperatively developed GER postoperatively, eight (20%) of whom required Nissen fundoplication (NF) or gastrojejunostomy (GJ) tube. Ten of 19 (53%) with preoperative C-GER but no R-GER continued to have GER after PEG, but only three required NF or GJ. Only one of nine children who had R-GER only developed clinical GER after PEG placement. Of the eight children with both C-GER and R-GER, only two (25%) required NF or GJ and two (25%) had no postoperative GER. The authors conclude that PEG tubes are useful in infants and children and are associated with a relatively low incidence of postoperative GER. If C-GER is absent, a PEG is a reasonable procedure to consider even in the presence of R-GER.
经皮内镜下胃造口术（PEG）与随后发生的胃食管反流（GER）之间的关系复杂且尚未完全明确。作者回顾性研究了82例在5年期间接受PEG管置入（n = 64）或PEG纽扣置入（n = 18）的儿童。术前通过上消化道造影或锝99m胃闪烁扫描评估儿童GER的临床证据（C-GER）或影像学GER（R-GER）。通过与家属直接联系对75例患者进行术后GER临床证据的评估。39例术前无GER的患者中有11例（28%）术后发生GER，其中8例（20%）需要行nissen胃底折叠术（NF）或胃空肠造口术（GJ）置管。19例术前有C-GER但无R-GER的患者中有10例（53%）在PEG术后仍有GER，但仅3例需要NF或GJ。9例仅患有R-GER的儿童中只有1例在PEG置管后发生临床GER。8例同时患有C-GER和R-GER的儿童中，只有2例（25%）需要NF或GJ，2例（25%）术后无GER。作者得出结论，PEG管对婴幼儿有用，且术后GER发生率相对较低。如果不存在C-GER，即使存在R-GER，PEG也是一个可考虑的合理手术。
