Gastric electrical stimulation in intractable symptomatic gastroparesis.
BACKGROUND
The treatment of gastroparesis remains unsatisfactory despite prokinetic and anti-emetic drugs. Gastric electrical stimulation has been proposed as a therapeutic option. We have assessed the effect of gastric electrical stimulation on symptoms, medical treatment, body weight and gastric emptying in patients with intractable symptomatic gastroparesis in a non-placebo-controlled study.


METHODS
In this multicenter study, 38 highly symptomatic patients with drug-refractory gastroparesis were enrolled. Patients first received temporary electrical stimulation using percutaneous electrodes. The 33 responders to temporary stimulation then underwent surgical implantation of a permanent stimulator. Severity of vomiting and nausea was assessed before and after stimulation. Patients were reassessed 3, 6, and 12 months after permanent implantation.


RESULTS
With stimulation, 35/38 patients (97%) experienced >80% reduction in vomiting and nausea. This effect persisted throughout the observation period (2.9-15.6 months, 341 patient-months). Gastric emptying did not initially change, but improved in most patients at 12 months. At 1 year, the average weight gain was 5.5% and 9/14 patients initially receiving enteral or parenteral nutrition were able to discontinue it.


CONCLUSIONS
Electrical stimulation of the stomach has an immediate and potent anti-emetic effect. It offers a safe and effective alternative for patients with intractable symptomatic gastroparesis.
Abell
Thomas L
TL
University of Mississippi Medical Center, Jackson, Miss 39216-4505, USA. tabell@medicine.umsmed.edu
Van Cutsem
Eric
E
Abrahamsson
Hasse
H
Huizinga
Jan D
JD
Konturek
J W
JW
Galmiche
Jean Paul
JP
VoelIer
Guy
G
Filez
Ludo
L
Everts
Bernt
B
Waterfall
William E
WE
Domschke
W
W
Bruley des Varannes
Stanislas
S
Familoni
Babajide O
BO
Bourgeois
Ivan M
IM
Janssens
Jozef
J
Tougas
Gervais
G
D000293:Adolescent; D000328:Adult; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000628:therapy; D004561:Transcutaneous Electric Nerve Stimulation; D014839:Vomiting / Q000628:therapy; D015430:Weight Gain