Electrical stimulation for gastroparesis. Gastric motility restored.
BACKGROUND
Gastroparesis is a disabling, and sometimes fatal, disease that often does not respond to medical treatment. This single-surgeon prospective study examines the safety and 6-month efficacy of electrical stimulation for the treatment of gastroparesis.


METHODS
Sixteen patients with medically refractory gastroparesis underwent laparoscopic implantation of an electrical stimulator device (Enterra Therapy, Medtronic, Minneapolis, MN, USA) consisting of a subcutaneous stimulator and two gastric wall leads. Gastric emptying scans (GES) confirmed the diagnosis of gastroparesis. Patients were evaluated preoperatively using a self-administered GI symptomatology questionnaire and RAND 36 Health Survey. Once patients were >6-months from implantation, a repeat GES was obtained and patients completed a postoperative GI symptomatology questionnaire and RAND 36 Health Survey. Ten of 16 patients in this case series were >6-months from implantation. One was lost to follow-up. An F-test was used to establish equality of standard deviations between the 16 patients evaluated preoperatively and the subset of 10 patients evaluated postoperatively. A Student's t-test was used to evaluate the significance of differences in pre- and postoperative results.


RESULTS
Average operating time was 117 min with no intraoperative complications. The majority of patients were discharged on postoperative day 1. There were two complications in the postoperative period. Patients experienced a significant decrease in nausea and vomiting as measured by the GI symptomatology questionnaire. Half of all patients no longer required gastric prokinetic medications and there was a subjective reduction of pyrosis, early satiety, and epigastric pain. A significant increase in quality of life as measured by the RAND 36 Health Survey was seen, and six of eight patients no longer demonstrated gastroparesis on GES.


CONCLUSIONS
Laparoscopic implantation of an electrical stimulation device is a safe and effective treatment by subjective and objective standards for the management of medically refractory gastroparesis.
de Csepel
J
J
Department of Surgery, St. Vincent's Hospital, 170 West 12 Street, New York, NY 10011, USA. jdecsepel@svcmcny.org
Goldfarb
B
B
Shapsis
A
A
Goff
S
S
Gabriel
N
N
Eng
H M
HM
D000328:Adult; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000592:standards; D004567:Electrodes, Implanted; D005260:Female; D005769:Gastrointestinal Motility; D018589:Gastroparesis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome