Evaluation and treatment of gastric stimulator failure in patients with gastroparesis.
OBJECTIVE
This study evaluates treatment of gastroparesis patients refractory to gastric electrical stimulation (GES) therapy with surgical replacement of the entire GES system.


BACKGROUND
Some patients who have symptomatic improvement with GES later develop recurrent symptoms. Some patients improve by simply altering pulse parameter settings. Others continue to have symptoms with maximized pulse parameters. For these patients, we have shown that surgical implantation of a new device and leads at a different gastric location will improve symptoms of gastroparesis.


METHODS
This study evaluates 15 patients with recurrent symptoms after initial GES therapy who subsequently received a second GES system. Positive response to GES replacement therapy is evaluated by symptoms scores for vomiting, nausea, epigastric pain, early satiety, and bloating using a modified Likert score system, 0 to 4.


RESULTS
Total symptom scores improved for 12 of 15 patients with GES replacement surgery. Total score for the replacement group decreased from 17.3 ± 1.6 to 13.6 ± 3.7 with a difference of 3.6 (P value = .017). This score is compared with that of the control group with a preoperative symptom score of 15.8 ± 3.6 and postoperative score of 12.3 ± 3.5 with a difference of 3.5 (P value = .011). The control group showed a 20.3% decrease in mean total symptoms score, whereas the study group showed a 22.5% decrease in mean with an absolute reduction of 2.2.


CONCLUSIONS
Reimplantation of a GES at a new gastric location should be considered a viable option for patients who have initially failed GES therapy for gastroparesis.
University of Mississippi Medical Center, Jackson, MS, USA.
Nancy Salloum
NS
Harrison
University of Mississippi Medical Center, Jackson, MS, USA.
Patrick A
PA
Williams
University of Mississippi Medical Center, Jackson, MS, USA.
Micah R
MR
Walker
University of Mississippi Medical Center, Jackson, MS, USA.
Yana
Y
Nikitini
University of Mississippi Medical Center, Jackson, MS, USA.
Thomas S
TS
Helling
University of Louisville, Louisville, KY, USA.
Thomas L
TL
Abell
University of Mississippi Medical Center, Jackson, MS, USA clahr@umc.edu.
Christopher J
CJ
Lahr
D000328:Adult; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D018589:Gastroparesis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
Enterra therapy; gastric electrical stimulation; gastroparesis