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. 2019 Jan;26(1):27-38.

Gastric Electric Stimulation for Refractory Gastroparesis

Bryan Zoll  1 , Asad Jehangir  1 , Zubair Malik  1 , Michael A Edwards  1 , Roman V Petrov  1 , Henry P Parkman  1
Affiliations

Gastric Electric Stimulation for Refractory Gastroparesis

Bryan Zoll et al. J Clin Outcomes Manag. 2019 Jan.

Abstract

Objective: To outline the use and utility of gastric electric stimulation (GES) as a therapeutic intervention for gastroparesis.

Methods: Review of the literature.

Results: Gastroparesis is characterized by delayed gastric emptying, with symptoms of nausea, vomiting, early satiety, postprandial fullness, and abdominal pain. Some patients with gastroparesis do not respond to medical intervention, and for these patients surgical intervention may be warranted. GES utilizes high-frequency gastric neurostimulation to facilitate gastric emptying and reduce symptoms of gastroparesis. It is indicated for patients with idiopathic and diabetic gastroparesis who have nausea and vomiting as their primary symptoms and who have not responded to medical therapy. GES has also been used in postsurgical and pediatric gastroparesis patients. Optimizing the outcome of this surgical treatment through proper patient selection and meticulous surgical technique is essential as there are inherent risks to the procedure. Nonblinded studies of GES for medically refractory gastroparesis have demonstrated therapeutic symptomatic benefit, whereas randomized controlled trials have not. New interventions such as pyloromyotomy and pyloroplasty are reasonable alternatives or addendums to GES.

Conclusion: GES may be considered among the therapies available for treating patients with refractory symptoms of gastroparesis. More studies, specifically those comparing GES, pyloromyotomy, GES combined with pyloromyotomy, and placebo, are needed to help guide therapy selection for refractory gastroparesis.

Keywords: diabetes; dysmotility; electric stimulation; gastric emptying; gastroparesis.

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Figures

Figure 1
Figure 1
Small bowel obstruction caused by wrapping of the small bowel loops around the stimulator leads.
Figure 2
Figure 2
Placement of the device in left upper quadrant, with leads coiled under the generator in the pocket.
Figure 3
Figure 3
Placement of the device in right lower quadrant with the long intraabdominal course of the leads visualized.
Figure 4
Figure 4
Hematoma at the site of the gastric electric stimulator implantation.
Figure 5
Figure 5
Abdominal radiograph documenting migration of a lead in a patient with recurrent symptoms and an abnormal impedance value.
See this image and copyright information in PMC

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