PERCUTANEOUS GASTROJEJUNOSTOMY VERSUS NISSEN FUNDOPLICATION FOR ENTERAL FEEDING OF THE NEUROLOGICALLY IMPAIRED CHILD WITH GASTROESOPHAGEAL REFLUX

To determine the optimal method of providing enteral feeding to neurol ogically impaired children with gastroesophageal reflux, Nissen fundop lication with simultaneous gastrostomy tube placement (NGT) was compar ed with anterograde percutaneous gastrojejunostomy (APGJ), a nonsurgic al procedure performed under fluoroscopic guidance. The records of 112 neurologically impaired children with gastroesophageal reflux were re trospectively reviewed; 68 had undergone NGT and 44 APGJ. Follow-up da ta were available for 45 NGT patients (mean age, 6.4 years) and 34 APG J patients (mean age, 7.9 years). Mean follow-up was 1.8 years in the NGT group and 2.5 years in the APGJ group. Complications resulting fro m either procedure were classified either as major, which included tre atment failures or morbidity resulting in prolonged hospitalization, o r as minor, those requiring outpatient treatment only or not directly caused by the procedure. The NGT group had a significantly higher inci dence of major complications in comparison with the APGJ group (33.3% vs 11.8%, p < 0.05). Ten patients (22.2%) in the NGT group required re operation for complications; six required a second NGT for wrap hernia , failure, and continued gastroesophageal reflux. Two patients (5.9%) in the APGJ group required surgery for complications; one of these eve ntually required an NGT, and the other had an intussusception that nec essitated a small-bowel resection. Minor complications were more commo n in the APGJ group than in the NGT group (44.1% vs 6.6%); the majorit y of complications were related to the jejunostomy tube. Premature rep lacement or reinsertion of the jejunostomy tube was necessary in 14 AP GJ patients (32%). The mortality rate was 8.8% in the NGT group and 5. 9% in the APGJ group (p = not significant). No death occurred within 3 0 days of either procedure. We conclude that APGJ is a safe alternativ e method for feeding the neurologically impaired child with gastroesop hageal reflux.