An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation

Abstract

Gastric electrical stimulation (GES) is effective to improve symptoms of nausea and vomiting in most patients, but very little is known about the effect of varying stimulation parameters. We analysed stimulation parameters in a pilot study of 22 patients (12 idiopathic, four diabetic and four postsurgical) with drug-refractory gastroparesis who did not respond optimally to initial settings. Patients underwent high-frequency/low energy GES using identical initial stimulation parameters: 5 mA of current, 330 micros pulse width, 14 Hz for 0.1 s on and 5.0 s off. Due to lack on optimal response, 22 patients underwent alteration of an algorithm using stimulation parameters. At follow-up (mean of 4.3 years) a dose-response relationship for charge, power and energy were compared with baseline for the whole group and for each diagnostic subgroup by anova data are reported as mean +/- SE. Based on the mean of individual dose-response curves, differences in data are charge, current per pulse and energy per pulse were noted for the whole group at follow up vs baseline. The subgroup of patients with postsurgical gastroparesis required the most energy using the algorithm. In conclusion, an algorithmic approach to identify optimal stimulation parameters in GES for individual patients is associated with symptom improvement. Also, certain subgroups appear to have different energy parameters. Based on this preliminary data, the use of an algorithm for some patients with GES is feasible and may have potential for clinical application. A randomized-controlled trial of different stimulation parameters for GES seems warranted.

Cisplatin-Induced Gastric Dysrhythmia and Emesis in Dogs and Possible Role of Gastric Electrical Stimulation

“…The parameters of GES were as follows: train on time of 0.1 s and off time of 5 s, and pulse width of 330 ls, frequency of 14 Hz and amplitude of 5 mA, i.e., every 5.1 s, two consecutive pulses were given with an interval of approximately 71.4 ms. These parameters were similar to those used in clinical studies [25][26][27]. Recording and Analysis of Gastric Myoelectrical Activity A multi-channel recording system (Acqknowledge, EOG 100A, Biopac Systems, Inc. Santa Barbara, CA, USA) was used to record GMA via the four pairs of serosal electrodes.…”

Gastric Electrical Stimulation Is Safe and Effective: A Long-Term Study in Patients with Drug-Refractory Gastroparesis in Three Regional Centers

“…Using model 7432 Physician Programmer and model 7457 MemoryMod software cartridge (Medtronic), the neurostimulator was programmed to standardized parameters (frequency 14 Hz, amplitude 5 mA, pulse width 330 µs, cycle On 0.1 s, cycle Off 5.0 s). Some patients (approximately 10%) underwent an algorithmic adjustment of the stimulation parameters to optimize symptom response [15]. …”

Diabetic Gastrointestinal Neuropathy: Elusive Diagnosis and Difficult Treatment

“…Moreover the Enterra settings in terms of frequency, energy and on/off periods were not always reported and in some cases success was claimed in nonresponders after adjustment of the frequency and energy delivered by the device. Thus it is difficult to draw straightforward conclusions on the overall efficacy of Enterra, especially as the mentors of this technique claim that in nonresponders (who usually have painful gastroparesis and make use of narcotics) good results may be obtained by adjusting voltage, frequency and on/off periods of stimulation [46]. Positive results have been undoubtedly obtained in the vast majority of cases reported in the literature.…”