Children with antral hypomotility and enteric neuropathy are more likely to improve with gastric electrical stimulation

OBJECTIVES: Gastric electrical stimulation (GES) improves symptoms and quality of life in children with refractory nausea and vomiting, but predictors of response remain unclear. This study evaluated whether antroduodenal manometry (ADM) results predict response to GES. METHODS: We completed a prospective cohort study of patients <21 years old who underwent GES placement at our institution (2011-2024) with a prior ADM. Data were gathered at baseline, after the 1-week temporary stimulation trial, and at 2, 6, and 12 months after GES placement. Patients completed the Symptom Monitor Worksheet (SMW) and Pediatric Quality of Life Inventory (PedsQL). ADM findings were categorized as normal, postprandial antral hypomotility, or neuropathic pattern of small bowel motility based on initial interpretation and/or expert review. Clinical response was defined as a > 1 point improvement in average SMW score from baseline to last follow-up. Linear mixed-effects regression assessed changes in SMW and PedsQL by ADM category. RESULTS: Forty-seven patients (mean age of 13.7 ± 4.5 years, 70.2% female) were included, and 82.9% had gastroparesis. ADM was abnormal in 28 (59.5%), 15 (31.2%) had postprandial antral hypomotility, and 16 (34%) had neuropathic pattern of small bowel motility, with three patients having both. Patients with postprandial antral hypomotility (p = 0.002) and neuropathic pattern of small bowel motility (p = 0.01) had statistically significant improvement in SMW scores, while those with normal ADM did not (p = 0.15). All groups improved in PedsQL. Clinical response occurred in 26.3% of patients with normal ADM versus 64.2% with abnormal ADM (odds ratio::4.85, 95% confidence interval: 2.5%-97.5%, 1.2-22.7). CONCLUSIONS: Children with postprandial antral hypomotility or neuropathic pattern of small bowel motility on ADM are more likely to experience symptomatic improvement from GES.