Gastric electrical stimulation: An emerging therapy for children with intractable gastroparesis

Table 2 Alternative therapies for refractory gastroparesis[2,3,19,21,22]

Therapy	Mechanism/Indication	Comments
Botulinum Toxin	Endoscopic intra-pyloric injection of botulinum toxin to relax the pylorus	Requires frequent injections
		No improvement in long term symptoms
Enteral tube feeds	Unintentional loss of 10 % or more of the body weight during a period of 3-6 mo, Refractory symptoms	Mechanical complications: Obstruction, displacement, or dislodgement of the tube.
		Gastrointestinal complications: formula intolerance, diarrhea, constipation,
		Hinders normal lifestyle and quality of life
Gastrostomy tube	May be used for venting of secretions to decrease vomiting and fullness	Poor choice for feeding due to delayed gastric emptying
PEG-J tube	Allows the patient to vent gastric secretions to decrease/prevent persistent emesis. Provides jejunal feedings	Migration of the J-tube extension into stomach
		Pyloric obstruction from J-tube
Jejunostomy tube	Stable access for reliable jejunal nutrient	Cannot vent stomach
	Delivery Avoids gastric penetration
Dual G and J tube	Two sites-one for venting and one for enteral nutrition	Increased risk of leakage, infection Cosmetic issues
Parenteral Nutrition	Indicated due to intolerance to enteral feeds	Central venous access required.
		High risk of line infections
		Time consuming, expensive, and intrusive into daily routines
		Anesthesia complications
Surgical Options
Pyloroplasty	Surgical procedure used to widen the pylorus	Radical approach
		Limited success
		Surgical and anesthesia complications
Gastrectomy	After failed medical therapy with severe symptoms	Palliative approach
		Nausea continues to be a problem
		High risk of surgical and anesthesia complications.
		Not reversible

PEG: Percutaneous endoscopic gastrostomy; PEG-J: Percutaneous endoscopic gastrostomy with jejunal extension tube.