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. 2014 Jul 31;20(3):287-93.
doi: 10.5056/jnm13137.

Electrical stimulation therapy for gastroesophageal reflux disease

Nicolaas F Rinsma  1 , Nicole D Bouvy  2 , Ad A M Masclee  1 , José M Conchillo  1
Affiliations

Electrical stimulation therapy for gastroesophageal reflux disease

Nicolaas F Rinsma et al. J Neurogastroenterol Motil. .

Abstract

Electrical stimulation therapy (EST) of the lower esophageal sphincter is a relatively new technique for the treatment of gastroesophageal reflux disease (GERD) that may address the need of GERD patients, unsatisfied with acid suppressive medication and concerned with the potential risks of surgical fundoplication. In this paper we review available data about EST for GERD, including the development of the technique, implant procedure, safety and results from open-label trials. Two short-term temporary stimulation and long-term open-label human trials each were initiated to investigate the safety and efficacy of EST for the treatment of GERD and currently up to 2 years follow-up results are available. The results of EST are promising as the open-label studies have shown that EST is a safe technique with a significant improvement in both subjective outcomes of symptoms and objective outcomes of esophageal acid exposure in patients with GERD. However, long-term data from larger number of patients and a sham-controlled trial are required before EST can be conclusively advised as a viable treatment option for GERD patients.

Keywords: Electrical stimulation therapy, Esophageal sphincter, lower, Gastroesophageal reflux disease.

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Figures

Figure 1.
Figure 1.
Lower esophageal sphincter (LES) stimulation system (EndoStim) consists of an implantable pulse generator (IPG), bipolar electrodes implanted in the LES and the leads connected to the IPG and an external programmer.
Figure 2.
Figure 2.
EndoStim implantable pulse generator implant is located in a subcutaneous pocket in the anterior abdominal wall and the bipolar electrodes are implanted in the lower esophageal sphincter muscle.
Figure 3.
Figure 3.
Effective primary peristalsis after a wet swallow (5 mL of water) with complete relaxation of the lower esophageal sphincter (LES) seen on high-resolution manometry during electrical stimulation therapy. LES-end expiratory pressure was 12 mmHg at baseline (A) which increased to 22 mmHg after 3 months of LES-electrical stimulation therapy (B).
Figure 4.
Figure 4.
Improvement of acid exposure time in the 2 open-label trials. Pre-EST, before electrical stimulation therapy; On-EST, during electrical stimulation therapy.
See this image and copyright information in PMC

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