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Gastric electrical stimulation for adolescents with intractable nausea and gastroparesis
Author(s) -
ISLAM S,
GOSCHE JR,
ABELL TL
Publication year - 2006
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/j.1365-2982.2006.00789_40.x
Subject(s) - nausea , gastroparesis , vomiting , gastric emptying , medicine , electrogastrogram , gastroenterology , stomach , anesthesia
Purpose: Gastric electrical stimulation (GES) has been performed in adults as a treatment for refractory nausea and vomiting, in patients who have failed medical treatment. It has not been systematically applied to individuals less than 18 years old with this problem. Methods: Six patients, one male, five female with chronic nausea and vomiting with a mean age of 15 years (range 13–18), were evaluated with gastric emptying studies and cutaneous electrogastrograms (EGG) for temporary GES. All patients had idiopathic gastroparesis. Five patients subsequently underwent placement of a permanent GES device ‐ four were done laparoscopically and one was open. Each patient had an intra operative EGG and in three patients, seromuscular biopsies from the stomach or jejunum were obtained as well. Symptoms were recorded at baseline, after temporary pacing and then after permanent pacing using a Likert scale (0–4 for each symptom with a total of 5 symptoms). Statistical analysis was performed using a paired student's t test and a value of <0.05 was considered significant. Results: At baseline, all patients were symptomatic and most had delayed solid gastric emptying and abnormal EGG. As a group, there was a significant improvement in nausea (3.4 ± 0.4–1.7 ± 0.3, p = 0.005), and combined symptoms score (11.3 ± 2.0–5.0 ± 1.5, p = 0.02). Gastric emptying and EGG values also improved. Biopsy was abnormal in 2 of 3 patients, showing diminished and abnormal Cajal cells in the two patients who had less improvement long term. Follow up ranged from 1–20 month, with an average of 9 month. Conclusions: GES can be successfully applied to adolescents with intractable nausea and gastroparesis symptoms. The role of the cells of Cajal in enteric motility needs investigation. Long term efficacy of this therapy in children needs to be established.