MORBIDITY IN NEUROLOGICALLY IMPAIRED CHILDREN AFTER PERCUTANEOUS ENDOSCOPIC VERSUS STAMM GASTROSTOMY

Neurologically impaired children frequently require a feeding gastrost omy. Few reports are available comparing the incidence of postoperativ e complications and symptomatic gastroesophageal reflux after endoscop ic versus operative Stamm gastrostomy in this group of children. We un dertook a retrospective study of 63 consecutive neurologically impaire d children requiring a feeding gastrostomy, with an average of 23 mont hs of follow-up. No child had symptomatic gastroesophageal reflux. Thi rty children had a percutaneous endoscopic gastrostomy and 33 had a St amm gastrostomy, depending on the preference of the surgeon. The two g roups were comparable in age range, cause of neurologic impairment, an d indication for gastrostomy. Minor complications occurred in 30%. All three major complications occurred after Stamm gastrostomy, including two postoperative deaths. Symptomatic gastroesophageal reflux develop ed in 60%. The incidence of fundoplication after gastrostomy was 10% i n the percutaneous endoscopic gastrostomy group and 39% after Stamm ga strostomy (p <.025). Morbidity was lower after percutaneous endoscopic gastrostomy than after Stamm gastrostomy in this group of neurologica lly impaired children. Fundoplication for symptomatic gastroesophageal reflux was infrequent after percutaneous endoscopic gastrostomy and s ignificantly more common after Stamm gastrostomy. Percutaneous endosco pic gastrostomy is recommended as the initial procedure in neurologica lly impaired children without symptomatic gastroesophageal reflux who require a feeding gastrostomy.