Mo1182 Esophageal Foreign Body in Children: A Nationwide Analysis of Hospitalized Cases in the United States, 2005-2012

found in success of preoperative nasogastric feeding trials (GT (50, 61.7%) vs GJ (48, 59.3%), p=0.9) or frequency of abnormal upper GI series (GT (4, 0.05%) vs GJ (3, 0.04%), p=0.4). Only 1 GT patient (1.2%) vs 6 GJ (7.4%) patients underwent impedance probe testing prior to GT tube placement. 4 GT patients (4.9%) vs 8 GJ patients (9.9%) had prior gastric emptying studies (p=0.19) with no differences in median percent gastric residual at 1 hr (GT 52% (IQR 39, 52) vs GJ 63% (45, 66.8), p=1.00). Conclusions: No differences in preoperative patient characteristics, including presence of aspiration or tolerance of nasogastric feeds, were seen in patients with successful gastric feeding as compared to those requiring conversion to GJ feeds. More prospective studies are needed to determine whether additional preoperative reflux or motility testing may help decipher which gastrostomy patients will need future transpyloric feeding. Mo1182 Esophageal Foreign Body in Children: A Nationwide Analysis of Hospitalized Cases in the United States, 2005-2012 Lindsay M. Moye, Ruihong Luo, Syed Abdul Basit, Altaf Dawood, Tatini Datta, Christian D. Stone Background: Foreign body ingestion occurs commonly in children and lodgment in the esophagus requires endoscopic removal. However, a broad, national analysis of children hospitalized for esophageal foreign body (EFB) has not been performed in the United States. The aims of this study were to determine temporal trend of hospitalized EFB and to assess risk factors for complications (perforation, need for surgery and ICU admission). Methods: Using data from the Nationwide Inpatient Sample 2005-2012, we identified children (age ≤ 17) with an ICD-9 confirmed diagnosis of EFB and who underwent endoscopic removal of EFB. Cases with esophageal / mediastinal tumors, achalasia and esophageal dysmotility were excluded. The outcomes of interest were the trend of annual hospitalization, geographic and demographic distribution of cases, in-hospital mortality, incidence of surgery and ICU admission, and complications of esophageal perforation and aspiration pneumonia. Independent risk factors for esophageal perforation and ICU admission were evaluated by logistic regression. Results: 17.465 EFB cases were identified (median age 2 years; 58% were aged 2 or below). Male (58%) and Caucasian (42%) children were most common. The three states with most cases were California, New York and Texas. The case numbers for EFB over the 8-year period of study decreased slightly (Spearmen correlation r=-0.77, p=0.03). The incidences of ICU admission, esophageal perforation and surgery were <1%. Median length of stay was 1 day. The rate of in-hospital mortality was 0.1%. Eosinophilic esophagitis was reported in 2.4% and the rate increased over the last four years for which data was available. Esophageal perforation (odds ratio [OR] = 5.6) and aspiration pneumonia (OR= 105) independently increased the risk of ICU admission. Female gender (OR=2.0) and aspiration pneumonia (OR=9.5) were significantly associated with esophageal perforation. Conclusions: Hospitalizations for EFB in children have declined slightly and are most common in children aged 2 or less. Mortality and complications of need for surgery or ICU are rare. The rate of concomitant eosinophilic esophagitis is increasing in pediatric cases of EFB.

IQR, interquartile range; NEC, necrotizing enterocolitis; SIP, spontaneous intestinal perforation; EN, enteral nutrition; PN, parenteral nutrition; IFALD, intestinal failure-associated liver disease; DB, direct bilirubin *Fisher's exact test or Wilcoxin rank-sum test

Mo1183 Endoscopic Findings in Patients With Feeding Difficulties Versus Patients Undergoing Reflux Assessment Punit N. Jhaveri, Pooja Jhaveri, Sara Naramore, Keith Williams, Douglas G. Field Background: Guidelines regarding endoscopic evaluation in children presenting with feeding difficulties are currently not established. Previous studies have shown that between 45-90% of children with feeding difficulties demonstrated some pathologic alteration on endoscopic evaluation. We aim to assess differences in endoscopic findings in children with feeding difficulties versus those who underwent endoscopy for the evaluation of gastroesophageal reflux. Methods: In a previous retrospective chart review, the records of 85 patients referred to a multidisciplinary feeding team and who underwent endoscopic evaluation were examined. The review revealed 45% had at least one histopathologic diagnosis. Our current review compares each of these 85 patients against three age and gender matched patients who underwent endoscopy during the same period for evaluation of gastroesophageal reflux but were not referred for feeding problems. Percentages of the histologic findings were compared between the two groups. Results: See charts. Histopathologic findings for reflux were noted in 23% (n=59) of the control group. This was the most common finding. Other findings included gastritis, eosinophilic esophagitis, duodenitis, and celiac disease. The frequency of these findings was similar to the frequency of the same findings in patients with feeding difficulties. Non-pathologic findings were observed in 151 patients, or 60%. This was in comparison to the 55% of non-pathologic findings in patients who did have feeding difficulties. Conclusions: This study, demonstrates that clinicians can expect a similar likelihood of discovering both histopathologic findings and nondiagnostic findings in patients who have clinical gastroesophageal reflux and those with feeding difficulties. Numerous studies have shown children with feeding problems also have a diagnosis of clinical gastroesophageal reflux. This study confirms those previous clinical correlations with objective histopathologic findings. Future research will examine the relation between various types of feeding problems and the presence of concurrent histopathological findings. To date, no research has attempted to examine the degree to which the gastrointestinal problems contribute to the development and maintenance of feeding problems. Endoscopic Findings in Children with Feeding Disorders (n=85)

Mo1181 Preoperative Evaluation Does Not Predict Risk of Conversion to Transpyloric Feeding in Gastrostomy Dependent Pediatric Patients Maireade E. McSweeney, Jessica B. Kerr, Janine Amirault, Rachel L. Rosen Background: Prior literature suggests that a proportion of pediatric patients undergoing gastrostomy tube (GT) placement, especially those with underlying neurologic disability, will require coversion to gastrojejunal (GJ) feeds. Limited literature exists as to whether preoperative assessments may predict which patients will go onto require GJ feeding. The goal of this study was to compare the preoperative evaluations between patients sucessfully maintained on gastrostomy feeds ("GT" patients) versus patients who failed GT feeds and required conversion to transpyloric feeding ("GJ" patients). Methods: We identified patients at Boston Children's Hospital who underwent GT placement and ultimately required GJ feeding between 2006-2013. These patients were matched according to age, neurologic, and cardiac status with a cohort of patients who remained GT dependent. Preoperative characteristics of both groups were compared in order to identify risk factors for conversion to GJ feeding. Proportions were compared using Chi-square analyses. Results: 81 GJ patients (median (IQR): age 14 (4, 57.5) months; weight 8.8 (4.6, 15) kg) were matched with 81 GT patients (median (IQR): age 14 (4.5, 57) months; weight 8.5 (5.2, 14.3) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16.5) months. No differences in comorbidities (neurologic or cardiac disease, prematurity, cancer, metabolic/genetic disorder, oropharyngeal malformation, or pulmonary disease) were found. No differences in preoperative gastrostomy evaluations were seen. Both groups had similar rates of nasogastric feeding trials (GT (60, 74.1%) vs GJ (58, 71.6%), p=0.7), upper GI series (GT (47, 58%) vs GJ (45, 55.6%), p=0.75), and modified swallow studies (GT (38, 46.9%) vs GJ (46, 56.8%), p=0.21). No differences in aspiration were seen with 22 GT patients (27.2%) having abnormal modified swallow studies compared to 29 GJ patients (35.8%, p=0.4). There were no differences

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AGA Abstracts

AGA Abstracts

Table 1. Characteristics & Outcomes