CAPS PaperFundoplication and gastrostomy versus percutaneous gastrojejunostomy for gastroesophageal reflux in children with neurologic impairment: A systematic review and meta-analysis
Section snippets
Search strategy
We conducted a systematic search of Medline, Embase, and Cochrane Central Register of Controlled Trials for studies of participants with gastroesophageal reflux treated with FG or GJ. A medical librarian helped us develop queries for each database to identify studies that mentioned fundoplication and gastrojejunostomy. These concepts were expanded to ensure that no studies were missed due to variation in syntax and nomenclature. We also performed manual searches of relevant journals, conference
Search results
An overview of the search strategy and results is depicted in Fig. 1. We identified a total of 556 participants from three retrospective observational studies that compared outcomes for FG (n = 431) and GJ (n = 125) [30], [31], [32]. Agreement between the first two investigators regarding inclusion was excellent (unweighted kappa 0.86, 95% confidence interval 0.57–1.00).
Excluded studies
The first article that was excluded following full text review was a qualitative study that explored quality-of-life issues among
Discussion
The evidence supporting the use of FG versus GJ for refractory gastroesophageal reflux in children with neurologic impairment is very low. Studies reported to date have been complicated by baseline differences between treatment groups and imprecision due to small numbers. We found that the rates of mortality and pneumonia following either procedure are similar, and that most causes of death do not appear to be related to complications of treatment or ongoing gastroesophageal reflux. The risk of
Declarations of interest
Dr. Michael Livingston is supported by the Clinician Investigator Program at McMaster University, which is funded through the Ontario Ministry of Health and Long-term Care. Dr. Peter Rosenbaum is a Canada Research Chair in Childhood Disability Research, Mentoring, and Dissemination. These agencies had no role in selecting the topic or developing the content of this review.
Acknowledgements
We would like to thank Dr. Gordon Guyatt, Dr. Deborah Cook, Dr. Rajendu Srivastava, Dr. Nathan Evaniew, and Dr. Lina Santaguida for their feedback and suggestions regarding the protocol. We would also like to thank Alla Iansavichene, MLIS for her assistance with developing and executing the search strategy.
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