Surgical outcomes after gastric electric stimulator placement for refractory gastroparesis.
BACKGROUND
Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution.


METHODS
A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement.


RESULTS
A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea.


CONCLUSIONS
Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obese patients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.
Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Deborah S
DS
Keller
Henry P
HP
Parkman
Daniel O
DO
Boucek
Abhinav
A
Sankineni
John E
JE
Meilahn
John P
JP
Gaughan
Sean
S
Harbison
D000293:Adolescent; D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005260:Female; D018589:Gastroparesis / Q000601:surgery*; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult