Original articles
Gastric electrical stimulation for children with intractable nausea and gastroparesis

https://doi.org/10.1016/j.jpedsurg.2007.10.005Get rights and content

Abstract

Purpose

Gastric electrical stimulation (GES) has been performed in adults as a treatment of refractory nausea and vomiting in patients who have failed medical treatment, but has not been used in children.

Methods

Nine patients with chronic nausea and vomiting with a mean age of 14 years were evaluated for temporary GES. All 9 patients subsequently underwent placement of a temporary followed by permanent GES device. Symptoms were recorded at baseline, after temporary GES, and then after permanent GES using a Likert scale for gastroparesis. Statistical analysis was performed using a paired Student's t test.

Results

At baseline, all patients were symptomatic and most had delayed solid gastric emptying. As a group, there was a significant improvement in combined symptoms score (P = .04), nausea (P = .039), and vomiting (P = .0016). Gastric emptying and electrogastrogram values did not change significantly. Follow-up ranged from 8 to 42 months, with 7 of the 9 patients reporting sustained improvement in symptoms and improved quality of life.

Conclusions

Gastric electrical stimulation can be successfully applied to adolescents with intractable nausea and gastroparesis symptoms who fail medical therapy. There is a significant improvement in symptoms over a prolonged period ,and there are no adverse effects of the GES. Long-term efficacy of this therapy in children needs to be established.

Section snippets

Methods

As part of the overall institutional humanitarian device exemption Institutional Review Board approval, data were prospectively collected on all patients younger than 18 years with a diagnosis of GP who had implantation of a temporary and/or permanent gastric pacemaker. Nine patients, 8 female and 1 male, with chronic nausea and vomiting were evaluated with gastric emptying studies using scintigraphic tests and cutaneous electrogastrograms (EGGs) for temporary GES. All 9 patients went on to

Results

Eight patients had either idiopathic (5) or postinfectious (3) GP, with one patient having postsurgical GP after multiple corrective operations for esophageal atresia with tracheoesophageal fistula (Table 1). Her last operation was 1 year before presentation with a redo ileocolic anastomosis. Two of the patients who developed presumed postinfectious GP were brother and sister. One patient also had insulin-dependent diabetes mellitus and lupus as preexisting conditions. Before any treatment, all

Discussion

Gastroparesis is a disabling condition with significant long-term consequences if symptoms cannot be improved [1]. It is perceived to be mostly an adult problem; however, there are some reports of GP in the pediatric age group, both diabetic associated and idiopathic or presumed postviral GP [5], [14], [15], [16], [17]. The treatment modalities that have been used in these children ranged from the conservative, with dietary modifications and medication, to the very aggressive, with subtotal

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