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Introduction
The purpose of this study was to better understand the long-term success of endoscopic treatment of primary VUR by estimating the incidence and timing of additional interventions.
Methods
We queried the Pediatric Health Information System database for patients whose records contained both an ICD-9 code for VUR (593.7) and a CPT code for endoscopic injection (52327) between 9/30/2007-9/30/2009. Patients with secondary VUR, prior VUR interventions, or >18years were excluded. Subject’s records were searched forward though 9/30/2014 to identify additional VUR interventions. Kaplan-Meier curves were constructed, with proxy follow-up defined as time of initial injection to end of study period.
Results
Two thousand seventy eight (2,078) subjects were identified with median follow-up of 5.75 years (range 5.0-6.9 years). 15.4% underwent additional procedure(s) (9.2% injection, 4.8% reimplantation, 1.3% injection, then reimplantation). Median time to second injection was 6 months (IQR 4-15 months) and to reimplantation was 11 months (IQR 5-21 months). There was a 10.1% probability of undergoing any re-intervention by 1 year, which increased to 15.3% by 5 years (figure 1).

Conclusion
Acknowledging limitations of administrative data, including the inability to determine procedure laterality and to capture patient migration, these data indicate that the re-intervention rate after endoscopic treatment of VUR is at least 15.4%. While most re-interventions occur within the first year, additional procedures occur up to 5.2 years after endoscopic treatment.