Does laparoscopy-aided gastrostomy placement improve or worsen gastroesophageal reflux in patients with neurological impairment?

Background/purpose: The purpose of this study was to retrospectively investigate whether laparoscopy-aided gastrostomy placement (LGP) improved or worsened gastroesophageal reflux (GER) in neurological impairment (NI) patients. Methods: Subjects included 26 NI patients nourished via nasogastric tubes (age, 1-17 years; median, 6 years). They were divided into groups based on the percentage of time with an esophageal pH <4.0 (reflux index: RI) before LGP: Group 1 (GI, n = 13), RI <5.0%; Group II (GH, n = 13), RI >= 5.0%. Acid/nonacid reflux episodes (RE) were evaluated using combined pH-multichannel intraluminal impedance (pH-MII) monitoring, and gastric emptying was measured with the C breath test before and after LGP. Results: RI and number of RE evaluated with pH analyses and number of total/acid distal and proximal bolus RE with pH-MH increased significantly in GI. RI and acid clearance time with pH analyses and number of total bolus RE with pH-MII decreased significantly in GH. Gastric emptying parameters did not change significantly in GI, whereas the half-gastric emptying time and gastric emptying coefficient improved significantly in GH. Conclusion: LGP reduces GER in NI patients with pathological GER by improving gastric emptying, although it has a paradoxical influence on those without pathological GER. (C) 2014 Elsevier Inc. All rights reserved.