Unexpected Malrotation in Patients with Congenital Heart Disease Undergoing Gastrostomy Tube Placement: Is Routine Preoperative Upper Gastrointestinal Series Imaging Necessary?

Our aim is to determine the rate of unexpected malrotation identified on routine preoperative upper gastrointestinal (UGI) contrast study in infants with congenital heart disease (CHD) prior to gastrostomy tube (GT) placement and quantify any associated delay in care. We performed a retrospective review of infants with CHD who underwent GT placement following initial cardiac surgery at a single center between 2016 and 2021. Patients were identified in the electronic medical record. Demographic information, indications for GT placement, and clinical course were collected. Variables were compared using Mann-Whitney test, with significance set at p < 0.05. One hundred and thirty-one infants with CHD underwent GT placement after cardiac surgery; 124 (94.7%) underwent preoperative UGI of which 119 (95.2%) were normal. Five studies were read as "could not rule out malrotation" and one infant had malrotation on UGI. Median time from UGI to surgery was 3 days. Median days from consult to GT placement was 3 days among those who underwent UGI and 2 days in those who did not (p = 0.34). Among infants with CHD, the rate of unknown malrotation is low. UGI contrast study prior to GT placement may be associated with surgical delay, unnecessary radiation exposure, and low value healthcare. If a child is tolerating gastric feeds prior to GT placement, routine UGI is unnecessary.