Esophageal biopsy does not predict clinical outcome after percutaneous endoscopic gastrostomy in children

Clinically symptomatic gastroesophageal reflux may occur after percutaneous endoscopic gastrostomy (PEG), Preoperative evaluation for gastroesophageal reflux does not reliably predict those individuals who will develop reflux unresponsive to medical management after PEG, Esophageal histology at the time of PEG might be used to identify patients at risk for developing intra ctable gastroesophageal reflux, The study aim was to correlate the clinical outcome after PEG with esophageal histology at the time of PEG insertion. A retrospective review of 68 consecutive children who had an esophageal bio psy obtained at the time of PEG insertion was undertaken. Preoperative eval uation, esophageal histology, and clinical outcomes were compared. Preopera tive gastroesophageal reflux was present in 23% of upper gastrointestinal s eries performed, in 10% of pH probe studies, and in 29% of reflux scans. Hi stology was normal in 57% of esophageal biopsies obtained at the time of PE G insertion. Symptomatic gastroesophageal reflux requiring antireflux surge ry or conversion to gas trojejunostomy developed in 10% of patients after P EG placement, Only one of these patients had esophagitis on biopsy. In conc lusion, preoperative esophageal histology does not reliably predict the dev elopment of symptomatic gastroesophageal reflux after PEG placement.