Temporary Endoscopic Stimulation in Gastroparesis-like Syndrome.
OBJECTIVE
Gastroparesis-like syndrome (GLS) is defined as gastroparesis-like symptoms with normal gastric scintigraphy. While the efficacy of gastric electrical stimulation (GES) in gastroparesis is well known, the utility of GES in GLS is largely unknown. Our aim was to clarify the role of GES in GLS. We implanted consecutive patients with symptoms of gastroparesis with temporary gastric electrical stimulation and observed changes in gastric scintigraphy and total symptom score.


METHODS
Five hundred and fifty-one patients suffering from symptoms of gastroparesis (nausea, vomiting, bloating/distension, anorexia/early satiety, and abdominal pain) with negative endoscopy underwent gastric scintigraphy with analysis of 1) solid radionuclide gastric emptying at 1, 2, and 4 hours (% remaining); 2) area under the gastric emptying curve (AUC) at 1, 2, and 4 hours; and 3) total gastric emptying test (GET) (the sum of 1, 2, and 4 hour values). Patients were stratified into: delayed gastric emptying, normal gastric emptying, and rapid gastric emptying (Appendix). Of the 551 patients in the larger cohort, 379 had implantation of temporary gastric electrical stimulation (tGES). Gastrointestinal symptoms and gastric emptying were com - pared pre and post tGES implantation.


RESULTS
After tGES, 2 hour gastric retention decreased (P < 0.01) for the delayed patients, and increased (P < 0.001) for normal and rapid patients. These changes were accompanied by improvements (P < 0.001) in vomiting, nausea, and total symptom scores in all 3 subgroups.


CONCLUSIONS
Gastric electrical stimulation may be an effective therapy for treating the symptoms of gastroparesis with normal gastric emptying. Further exploration of endoscopic electrical stimulation as a treatment for gastroparesis-like symptoms with non-delayed gastric emptying is needed.
Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.|Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Sanjeev
S
Singh
Division of Gastroenterology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Jeff
J
McCrary
Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Archana
A
Kedar
Division of Gastroenterology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Stephen
S
Weeks
Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Brian
B
Beauerle
Division of Gastroenterology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Andrew
A
Weeks
Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Omer
O
Endashaw
Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Chris
C
Lahr
Starkebaum and Associates, Plymouth, Minnesota, USA.
Warren
W
Starkebaum
Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.|Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Thomas
http://orcid.org/0000-0002-3175-5161
T
Abell
Abdominal pain; Electrical stimulation; Gastroparesis; Nausea; Vomiting