Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis.
OBJECTIVE
The aim of this study was to report the long-term clinical response to high-frequency gastric electrical stimulation (GES) in 16 patients with postsurgical gastroparesis who failed standard medical therapy.


METHODS
Clinical data collected at baseline and after 6 and 12 months of GES included (1) severity and frequency of 6 upper gastrointestinal (GI) symptoms by using a 5-point symptom interview questionnaire and total symptom score, (2) health-related quality of life including physical composite score and mental composite score, (3) 4-hour standardized gastric emptying of a solid meal by scintigraphy, and (4) nutritional status.


RESULTS
The severity and frequency of all 6 upper GI symptoms, total symptom score, physical composite score, and mental composite score were significantly improved after 6 months and sustained at 12 months ( P < .05). All patients had delayed gastric emptying at baseline. Gastric emptying was not significantly faster at 12 months, although 3 normalized. At implantation, 7 of 16 patients required nutritional support with a feeding jejunostomy tube; after GES, 4 were able to discontinue jejunal feeding. The mean number of hospitalization days was significantly reduced by a mean 25 days compared with the prior year. One patient had the device removed after 12 months because of infection around the pulse generator.


CONCLUSIONS
Long-term GES significantly improved upper GI symptoms, quality of life, the nutritional status, and hospitalization requirements of patients with postsurgical gastroparesis. Although vagal nerve damage or disruption was part of the underlying pathophysiology, GES therapy was still effective and is a potential treatment option for the long-term management of postsurgical gastroparesis. A controlled clinical trial of GES for PSG patients (who are refractory to medical therapy) is indicated given these encouraging results.
McCallum
Richard
R
Department of Medicine, Mail stop: 1058, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. rmccallu@kumc.edu
Lin
Zhiyue
Z
Wetzel
Paul
P
Sarosiek
Irene
I
Forster
Jameson
J
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome