Just because you can't teach an old dog new tricks (or so they say) doesn't mean you can't turn new tricks with an old device. Doctors at Nationwide Children's Hospital (Columbus, Ohio) have found a new way to use a pacemaker – an implantable device typically used to treat heart problems in adults.
In June, surgeons implanted a pacemaker in a 16-year-old patient with gastroparesis, a debilitating stomach condition that affects the way the body processes food. According to the hospital, this is the first time the procedure has been performed in a child there, and it is now one of only a handful of institutions across the country offering this type of treatment in children.
The device is inserted into the abdomen, with electrical wires leading to the stomach. It sends electrical impulses to stimulate the stomach after eating.
"The pacemaker is surgically implanted under the skin and is connected to two electrodes placed on the stomach wall. It tells the stomach to empty at a certain frequency. The initial settings are fairly low and, as with a pacemaker in the heart, we can change the settings as needed," said pediatric surgeon Steven Teich, MD, surgical director of the Bariatric Surgery Program at Nationwide Children's Hospital and clinical assistant professor of surgery at Ohio State University College of Medicine (Columbus). "It empties the stomach, alleviating bloating, vomiting and nausea."
Teich told Medical Device Daily that the pacemaker used in the 16-year-old patient was made by Medtronic (Minneapolis). Prior to the procedure, the patient had chronic nausea, vomiting, bloating, and constipation, he said. She had tried all the various medications available for gastroparesis without success, Teich said. Because the patient had undergone previous surgeries, the procedure was done as an open surgery. However, he told MDD that it can be performed as a laparoscopic procedure instead.
Since receiving the pacemaker, the teenager's nausea and vomiting have "improved significantly," Teich said, however she does still have some bloating.
According to Nationwide Children's Hospital, gastroparesis is a condition where the stomach contracts less often and less powerfully, causing food and liquids to stay in the stomach for a long time. In as many as 60% of children with gastroparesis, the cause is not known. The condition often leaves children feeling constantly bloated and nauseated and can result in malnourishment and significant weight loss. In severe cases, symptoms may prevent children from attending school or taking part in other daily activities, the hospital noted.
Pacemakers have been used for years in adults with diabetes and gastroparesis, or delayed gastric emptying, but Teich said the device has only been used for that purpose a few times in adolescent patients.
According to Nationwide Children's Hospital, the hospital received IRB approval to implant the device in children as a humanitarian device exemption through the FDA, and although this is a new procedure in children and adolescents, doctors there say the early results are promising.
"In patients who have received this type of treatment, nearly all symptoms were resolved within two weeks," said pediatric gastroenterologist Hayat Mousa, MD, medical director of the Motility Center at Nationwide Children's Hospital and associate professor of Clinical Pediatrics at Ohio State University College of Medicine. "Previous treatment options, including medications, have been much less effective."
Nationwide Children's Hospital says it is the only children's hospital in the nation that offers the full spectrum of treatment options for motility disorders, including diagnosis, medications, endoscopic procedures, surgical options, pacemakers and follow up care.
"I think we're going to see more patients with gastroparesis ... just because we can offer the whole spectrum," Teich said.