Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2019; 25(48): 6880-6889
Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6880
Gastric electrical stimulation: An emerging therapy for children with intractable gastroparesis
Aniruddh Setya, Priyanka Nair, Sam Xianjun Cheng
Aniruddh Setya, Priyanka Nair, Sam Xianjun Cheng, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sam Xianjun Cheng, MD, MSc, PhD, Assistant Professor, Doctor, Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Road, HD 600, Gainesville, FL 32610, United States. sam.cheng@ufl.edu
Received: September 27, 2019
Peer-review started: September 24, 2019
First decision: December 5, 2019
Revised: December 13, 2019
Accepted: December 21, 2019
Article in press: December 22, 2019
Published online: December 28, 2019
Processing time: 94 Days and 17 Hours
Abstract

Management of gastroparesis remains challenging, particularly in pediatric patients. Supportive care and pharmacological therapies for symptoms remain the mainstay treatment. Although they are effective for mild and some moderately severe cases, often time they do not work for severe gastroparesis. There are a few prokinetics available, yet the use of these drugs is limited by a lack of persistent efficacy and/or safety concerns. Currently, the only modality for adult patients with severe intractable gastroparesis is surgery, e.g., pyloroplasty and partial gastrectomy, however, this option is generally considered too radical for a growing child. Novel therapeutic approaches, particularly those which are less invasive, are needed. This article explores gastric electrical stimulation (GES), a new therapy for gastroparesis. Unlike others, it neither needs medications nor gastrectomy; rather, it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach. Thus, it is tolerated and safe in children. Like in adult patients, GES appears to work in releasing symptoms, improving nutrition, and enhancing the quality of life; it also helps wean off medications and eliminate many needs for hospitalization. Considering the transient nature of gastroparesis in children in many occasions, GES is considered a “bridging” therapy after failed medical interventions and before surgery.

Keywords: Gastroparesis; Gastric electrical stimulation; Nausea; Vomiting; Prokinetics

Core tip: Gastric Electrical Stimulation is an effective, safe and feasible therapy for pediatric patients with symptoms of intractable nausea and vomiting due to medically refractive gastroparesis. It works through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach. Even though the mechanism is not completely understood, it provides a “bridge” before radical surgical options and can potentially lead to an improved quality of life by helping in weaning off medications and reducing hospitalizations.