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Feasibility and safety of gastric electrical stimulation for a child with intractable visceral pain and gastroparesis.

Vomiting associated with gastroparesis decreased by 50% with gastric electrical stimulation in adults with diabetic neuropathy (1). Gastric electrical stimulation (GES) improved symptoms associated with gastroparesis without altering gastric emptying (2–4), in part because of reducing sensory sensitivity (5). Electrical stimulation differs from electrical pacing. In electrical stimulation the current uses low energy and high frequency, and does not alter motility patterns (6). In contrast, electrical pacing uses higher energy, low frequency current timed to synchronize with slow wave rhythms of the tissue (eg, 3 cycles/min in the gastric antrum, 12/min in the duodenum). The current limitation to gastric pacing is that at present there is no implantable power source (3). The gastric electrical stimulator is an implantable device, similar in size to a cardiac pacemaker. The neurostimulator contains an electronic circuit and a battery and is implanted under the skin in the abdominal wall. The electronic circuit provides the electrical pulses delivered by the stimulator, and the battery provides energy needed for 5 to 10 years of operation. Both battery and electronic circuit are encapsulated in titanium housing, referred to as the pulse generator unit (4). On the basis of the Worldwide Anti-Vomiting Electrical Stimulation Study data (2), the US Food and Drug Administration approved GES with high frequency and low energy parameters (Enterra Therapy System, Medtronic, Minneapolis, MN) in March 2000 under a