Neurostimulation of the gastrointestinal tract in children: is it time to shock the gut?

Abstract

Although neurostimulation-based treatments appear promising and offer advantages compared to more invasive surgical treatment options, evidence for their benefit in children remains limited. High-quality studies demonstrating safety and efficacy and a better understanding of the mechanism of each modality are needed before there is more widespread acceptance of neurostimulation in the treatment of children with gastrointestinal disorders.

Gastroparesis in the Pediatric Patient: Children Are Not Little Adults

“…Gastric electrical stimulation involves the application of high-frequency, low-energy electrical stimulation via electrodes implanted along the greater curvature of the stomach. Gastric electrical stimulation has been used for adults with nausea and vomiting refractory to conventional treatment for over two decades and in children for over the past decade [36]. The literature supporting its use in adults has been growing over time, most recently after a randomized controlled trial of 172 patients treated with gastric electrical stimulation demonstrated significantly improved vomiting scores when the stimulator was on compared to off [37].…”

Pediatric enteric neuropathies: diagnosis and current management

“…GES involves delivery of low-energy electrical stimulation via electrodes implanted into the stomach. [28] The largest pediatric study to date included 97 children, 67 of whom had permanent pulse generators implanted and exhibited significant and sustained symptomatic improvement. [29] Additional studies are needed to confirm these findings and to determine mechanisms of action, predictors of success, and long-term efficacy.…”

Transcutaneous posterior tibial nerve stimulation in children and adolescents with functional constipation

“…On the other hand, a subtype of TES termed posterior tibial nerve stimulation (PTNS) involves electrical stimulation at the level of the ankle, delivered either percutaneously by needle punctures or transcutaneous through electrodes fixated on the overlying skin. [20] PTNS transcutaneous can be considered a minimally invasive, and accessible technique with the potential to improve constipation in the pediatric population. [20,21] Stimulation of the tibial nerve can modulate urinary and defecatory function through the stimulation of sacral nerves, similar to those exercised by sacral nervous stimulation (SNS).…”

“…[20] PTNS transcutaneous can be considered a minimally invasive, and accessible technique with the potential to improve constipation in the pediatric population. [20,21] Stimulation of the tibial nerve can modulate urinary and defecatory function through the stimulation of sacral nerves, similar to those exercised by sacral nervous stimulation (SNS). On the other hand, PTNS has the advantage of not requiring surgical procedures for the implantation of electrodes as in SNS.…”

“…On the other hand, PTNS has the advantage of not requiring surgical procedures for the implantation of electrodes as in SNS. [20–22] Multiple studies have shown that PTNS is useful for improvement of fecal incontinence in adults and treatment of several urinary dysfunctions in childhood. [21,23,24]…”