Baseline predictive factors for foregut and hindgut response to long‐term gastric electrical stimulation using augmented energy

Abstract

Introduction: Gastric electrical stimulation (GES) has been recommended for drug refractory patients with gastroparesis, but no clear baseline predictors of symptom response exist. We hypothesized that long-term predictors to GES for foregut and hindgut symptoms exist, particularly when using augmented energies. Patients:We evaluated 307 patients at baseline, 1 week post temporary GES, and one year after permanent GES. Baseline measures included upper and lower symptoms by patient-reported outcomes (PRO), solid and liquid gastric emptying (GET), cutaneous, mucosal, and serosal electrophysiology (EGG, m/s EG), BMI, and response to temporary stimulation.Methods: Foregut and hindgut PRO symptoms were analyzed for 12-month patient outcomes. All patients utilized a standardized energy algorithm with the majority of patients receiving medium energy at 12 months. Patients were categorized based on change in average GI symptom scores at the time of permanent GES compared to baseline using a 10% decrease over time as the cutoff between improvers versus non-improvers.Results: By permanent GES implant, average foregut and hindgut GI symptom scores reduced 42% in improved patients (n = 199) and increased 27% in non-improved patients (n = 108). Low BMI, baseline infrequent urination score, mucosal EG ratio, and proximal mucosal EG low-resolution amplitude remained significant factors for improvement status.Conclusions: GES, for patients responding positively, improved both upper/foregut and lower/hindgut symptoms with most patients utilizing higher than nominal energies. Low baseline BMI and the presence of infrequent urination along with baseline gastric electrophysiology may help identify those patients with the best response to GES/bio-electric neuromodulation.

Nutritional Assessment in Patients after Gastric Electrical Stimulation (GES)

“…This uses a 0-4 scale from (0=low, 4=high) 9,10 . The Lower GI and GU data were examined and recently-published work has shown that hindgut function can be a predictor of response to GES 11 …”

Gastric electrical stimulation: Overview and summary

“…Based on current practice, many patients end up with settings of about 15 milliamps with 2 seconds on and 3 seconds off. [ 9 ]…”

“…Other subtypes of Gp have not been as well studied but some predictors of response to GES, including low BMI and the presence of hindgut symptoms, have recently been described. [9] Some patients receive GES off-label use of GES for post-surgical Gp symptoms, and who may or may not have delayed solid gastric emptying on testing. Other patients have symptoms of Gp but with non-delayed solid gastric emptying-the so called gastroparesis-like syndrome (GLS) or severe functional dyspepsia (FD)may receive GES devices, particularly if they respond to a trial of temporary GES.…”

“…Other subtypes of Gp have not been as well studied but some predictors of response to GES, including low BMI and the presence of hindgut symptoms, have recently been described. [ 9 ]…”