Pacientes pediátricos com problemas neurológicos crônicos sempre exigem a realização de fundoplicatura associada à gastrostomia?
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Data
2023-08-02
Autores
Amorim, Paulo Cezar Haddad de
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Universidade Estadual Paulista (Unesp)
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Introdução: Os novos conhecimentos, principalmente na área da neonatologia, têm aumentado a expectativa de vida dos pacientes encefalopatas, trazendo discussões sobre seus cuidados. Esses pacientes apresentam uma avaliação complicada de seus sinais e sintomas, devido a sua dificuldade de se expressar. Uma das principais consequências da neuropatia é a incoordenação da deglutição e o refluxo patológico que pode estar presente nesse processo. Para tratar essa complicação, a principal alternativa para uma via de alimentação a longo prazo é a gastrostomia, que nos dias atuais, vem sendo feita de forma endoscópica, devido à sua praticidade e baixos níveis de complicações. Antigamente a fundoplicatura, procedimento realizado para evitar o refluxo gastroesofágico, era comumente associada à gastrostomia. Atualmente, a Sociedade Europeia de Gastroenterologia, Hepatologia e Nutrição Pediátrica (ESPGHAN) e a Sociedade Norte Americana de Gastroenterologia, Hepatologia e Nutrição Pediátrica (NASPGHAN) orientam a não realização da fundoplicatura no mesmo tempo cirúrgico. Contudo, na prática o que se observa é que a maioria dos cirurgiões pediátricos brasileiros ainda não adotou essa nova recomendação. Objetivo: Avaliar retrospectivamente o seguimento a longo prazo de pacientes com problemas neurológicos submetidos à gastrostomia endoscópica, sem fundoplicatura associada. Métodos: Análise retrospectiva de 2015 a 2020 de todos os pacientes encefalopatas, atendidos no serviço de Cirurgia Pediátrica da Faculdade de Medicina de Botucatu, entre 0 a 18 anos submetidos à gastrostomia endoscópica no Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp, que tiveram pelo menos 3 meses de seguimento pós operatório, utilizando prontuário eletrônico em conjunto com questionário via telefone para obtenção de dados. Resultados: 105 pacientes atendiam aos critérios de inclusão. Foi possível o contato através de ligação telefônica com 87 desses pacientes, dos quais 32 não possuíam todos os dados necessários em prontuário, sendo excluídos; três pacientes os pais ou cuidadores optaram por não participar, restando 52 pacientes que possuíam todos os critérios de inclusão e concordaram em participar do estudo. Não houve significância estatística na comparação entre o número de tratamentos de pneumonia e internações em Unidade de Terapia Intensiva (UTI) antes da cirurgia e após a gastrostomia, além de não apresentar significância estatística à análise de sintomas relacionados ao refluxo após cirurgia. Conclusão: Corroborando com as recomendações da NASPGHAN e da ESPGHAN, o presente estudo mostrou que não há a necessidade de realizar a fundoplicadura de rotina em conjunto com a gastrostomia.
Introduction: New knowledge, mainly in the area of neonatology, has increased the life expectancy of patients with encephalopathy, bringing discussions about their care. These patients present a complicated evaluation of their signs and symptoms, due to their difficulty in expressing themselves. One of the main consequences of neuropathy is the incoordination of swallowing and the pathological reflux that may be present in this process. To treat this complication, the main alternative for a long-term feeding route is gastrostomy, which nowadays is being performed endoscopically, due to its practicality and low levels of complications. In the past, deep plication, a procedure performed to prevent gastroesophageal reflux, was commonly associated with gastrostomy. Currently, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) advise against performing fundoplication at the same surgical time. However, in practice, what is observed is that most Brazilian pediatric surgeons have not yet adopted these new recommendations. Objective: To retrospectively evaluate the long-term follow-up of patients with neurological problems who underwent endoscopic gastrostomy without associated fundoplication. Methods: Retrospective analysis from 2015 to 2020 of all patients with encephalopathy, treated at the Pediatric Surgery service of the Faculdade de Medicina de Botucatu, between 0 and 18 years old, who underwent endoscopic gastrostomy at the Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp, who had at least 3 months of postoperative follow-up, using an electronic medical record together with a telephone questionnaire to obtain data. Results: 105 patients met the inclusion criteria. It was possible to contact 87 of these patients via telephone call, of which 32 did not have all the necessary data in their medical records, being excluded, three patients whose parents or caregivers chose not to participate, leaving 52 patients who met all the inclusion criteria and agreed to participate in the study. An analysis was carried out that did not identify statistical significance comparing the number of pneumonia treatments and ICU (Intesive Care Unit) admissions before surgery and after gastrostomy, in addition to the analysis of symptoms related to reflux after surgery not showing statistical significance. Conclusion: Corroborating the NASPGHAN and ESPGHAN recommendations, the present study showed that there is no need to perform routine fundoplication in conjunction with the gastrostomy.
Introduction: New knowledge, mainly in the area of neonatology, has increased the life expectancy of patients with encephalopathy, bringing discussions about their care. These patients present a complicated evaluation of their signs and symptoms, due to their difficulty in expressing themselves. One of the main consequences of neuropathy is the incoordination of swallowing and the pathological reflux that may be present in this process. To treat this complication, the main alternative for a long-term feeding route is gastrostomy, which nowadays is being performed endoscopically, due to its practicality and low levels of complications. In the past, deep plication, a procedure performed to prevent gastroesophageal reflux, was commonly associated with gastrostomy. Currently, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) advise against performing fundoplication at the same surgical time. However, in practice, what is observed is that most Brazilian pediatric surgeons have not yet adopted these new recommendations. Objective: To retrospectively evaluate the long-term follow-up of patients with neurological problems who underwent endoscopic gastrostomy without associated fundoplication. Methods: Retrospective analysis from 2015 to 2020 of all patients with encephalopathy, treated at the Pediatric Surgery service of the Faculdade de Medicina de Botucatu, between 0 and 18 years old, who underwent endoscopic gastrostomy at the Hospital das Clínicas da Faculdade de Medicina de Botucatu – Unesp, who had at least 3 months of postoperative follow-up, using an electronic medical record together with a telephone questionnaire to obtain data. Results: 105 patients met the inclusion criteria. It was possible to contact 87 of these patients via telephone call, of which 32 did not have all the necessary data in their medical records, being excluded, three patients whose parents or caregivers chose not to participate, leaving 52 patients who met all the inclusion criteria and agreed to participate in the study. An analysis was carried out that did not identify statistical significance comparing the number of pneumonia treatments and ICU (Intesive Care Unit) admissions before surgery and after gastrostomy, in addition to the analysis of symptoms related to reflux after surgery not showing statistical significance. Conclusion: Corroborating the NASPGHAN and ESPGHAN recommendations, the present study showed that there is no need to perform routine fundoplication in conjunction with the gastrostomy.
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Palavras-chave
DRGE, Gastrostomia, Neuropatia, Encefalopatia, Fundoplicatura, Endoscopia, Cirurgia pediátrica, Refluxo