Gastric Electrical Stimulation and Sacral Electrical Stimulation: A Long-Term Follow-Up Study of Dual-Device Treatment

Agrawal, Anubhav; Francis, Sean L.; Deveneau, Nicolette E.; Jain, Shaily; Abrasley, Christopher; McNeese, Jason T.; Kothari, Shivangi; Lahr, Christopher J.; Abell, Thomas L.

doi:10.1007/s10620-015-3840-4

Cited by 10 publications

(11 citation statements)

References 16 publications

(17 reference statements)

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“…Older work has shown that GES can also improve pancreatic function in patients with the symptoms of gastroparesis, likely via a vagal mechanism . Recent work with temporary and permanent GES has reported an effect on the small bowel and colon . However, one randomized sensory study did not reveal a central effect of GES in humans .…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Abell

Yamada

McCallum

et al. 2019

Neurogastroenterology Motil

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Background Gastric electrical stimulation (GES) for treating gastroparesis symptoms is controversial. Methods We studied 319 idiopathic or diabetic gastroparesis symptom patients from the Gastroparesis Clinical Research Consortium (GpCRC) observational studies: 238 without GES and 81 with GES. We assessed the effects of GES using change in GCSI total score and nausea/vomiting subscales between baseline and 48 weeks. We used propensity score methods to control for imbalances in patient characteristics between comparison groups. Key Results GES patients were clinically worse (40% severe vs. 18% for non‐GES; P < .001); worse PAGI‐QOL (2.2. vs. 2.6; P = .003); and worse GCSI total scores (3.5 vs. 2.8; P < .001). We observed improvements in 48‐week GCSI total scores for GES vs. non‐GES: improvement by ≥ 1‐point (RR = 1.63; 95% CI = (1.14, 2.33); P = .01) and change from enrollment (difference = −0.5 (−0.8, −0.3); P < .001). When adjusting for patient characteristics, symptom scores were smaller and not statistically significant: improvement by ≥ 1‐point (RR = 1.29 (0.88, 1.90); P = .20) and change from the enrollment (difference = −0.3 (−0.6, 0.0); P = .07). Of the individual items, the nausea improved by ≥ 1 point (RR = 1.31 (1.03, 1.67); P = .04). Patients with GCSI score ≥ 3.0 tended to improve more than those with score < 3.0. (Adjusted P = 0.02). Conclusions and Inferences This multicenter study of gastroparesis patients found significant improvements in gastroparesis symptoms among GES patients. Accounting for imbalances in patient characteristics, only nausea remained significant. Patients with greater symptoms at baseline improved more after GES. A much larger sample of patients is needed to fully evaluate symptomatic responses and to identify patients likely to respond to GES.

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Section: Discussionmentioning

confidence: 99%

“…14 Recent work with temporary and permanent GES has reported an effect on the small bowel 40 and colon. 35,41 However, one randomized sensory study did not reveal a central effect of GES in humans. 42 Other work, however, a Linear regression was used with the change in GCSI total score as an outcome.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Abell

Yamada

McCallum

et al. 2019

Neurogastroenterology Motil

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“…Newer studies have elucidated the effects of GES on the mid gut and hind gut. In a 2016 study [31], 54 patients who underwent dual-device treatment (GES and sacral electrical stimulation) were followed for 24 months. With combined treatment, a statistically significant improvement was seen in upper GI, lower GI and genitourinary symptoms as well as quality of life.…”

Section: Mid-gut and Hind-gut Effectmentioning

confidence: 99%

Role of Gastric Electrical Stimulation in the Treatment of Gastroparesis

Shine

Abell

2020

Gastrointestinal Disorders

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Introduction: Gastric electrical stimulation (GES) is a surgically implanted treatment option for drug refractory gastroparesis syndromes. Evidence supporting use of GES and the pathophysiology of gastroparesis syndromes is not widely known. We conducted a descriptive review to elucidate the pathophysiology of gastroparesis syndromes, with particular focus on gastrointestinal neuromodulation and the known mechanisms of action of GES. Methods: A descriptive review of PubMed, Web of Science and Cochrane Library was conducted using the keywords gastric electrical stimulation, gastroparesis, nausea, vomiting, neuromodulation, gastroparesis syndromes, central nervous system, gastric pacing and electrical stimulation. Results: 1040 potentially relevant articles were identified, of which 34 were included. These studies explored various central and peripheral effects of GES, as well as its effect on quality of life, hospital stay, mortality and health-related costs. Conclusion: Although evidence supporting gastrointestinal (GI) electrical stimulation and GI neuromodulation use is not widely known, GES does seem to offer significant improvement in symptom control, quality of life and other effects to many patients. GES exerts its effects through multiple central and peripheral mechanisms and has potential to modify the natural history of disease. Future work on gastroparetic syndromes and their treatment might be better focused in terms of pathophysiologic mechanisms. Improving outcomes with specific neuromodulation therapies, like GES, may offer improvements in health for many patients with refractory upper gastrointestinal symptoms.

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“…Although the pathophysiology of motility disorders is not fully understood, impaired GI electrical activity is frequently correlated [3-8]. Studies have shown that GI electrical activity is measurable with smooth-muscle electromyography (EMG) and that GI motility can be modified with electrical stimulation (ES) [9-14]. Thus, a multilocular ES of the GI tract may be a promising mid- or long-term therapy for medically refractory GI motility disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, a multilocular ES of the GI tract may be a promising mid- or long-term therapy for medically refractory GI motility disorders. However, to date, few studies have investigated the effects of multilocular ES in multiple segments of the GI tract in animals or humans [12-14]. We recently described successful modulation of electrical activity in 5 GI segments using variable ES [15].…”

Section: Introductionmentioning

confidence: 99%

Robotic Setup Promises Consistent Effects of Multilocular Gastrointestinal Electrical Stimulation: First Results of a Porcine Study

et al. 2020

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Background: Electrical stimulation (ES) of several gastrointestinal (GI) segments is a promising therapeutic option for multilocular GI dysmotility, but conventional surgical access by laparotomy involves a high degree of tissue trauma. We evaluated a minimally invasive surgical approach using a robotic surgical system to perform electromyographic (EMG) recordings and ES of several porcine GI segments, comparing these data to an open surgical approach by laparotomy. Materials and Methods: In 5 acute porcine experiments, we placed multiple electrodes on the stomach, duodenum, jejunum, ileum, and colon. Three experiments were performed with a median laparotomy and 2 others using a robotic platform. Multichannel EMGs were recorded, and ES was sequentially delivered with 4 ES parameters to the 5 target segments. We calculated pre-and poststimulatory spikes per minute (Spm) and performed a statistical Poisson analysis. Results: Electrode placement was achieved in all cases without complications. Increased technical and implantation time were required to achieve the robotic electrode placement, but invasiveness was markedly reduced in comparison to the conventional approach. The highest calculated (c)Spm values were found in the poststimulatory period of the small bowel with both the conventional and robotic approaches. Six of the 20 Poisson test results in the open setup reached statistical significance and 12 were significant in the robotic experiments. Conclusions: The robotic setup was less invasive, revealed more consistent effects of multilocular ES in several GI segments, and is a promising option for future preclinical and clinical studies of GI motility disorders.

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Gastric Electrical Stimulation and Sacral Electrical Stimulation: A Long-Term Follow-Up Study of Dual-Device Treatment

Cited by 10 publications

References 16 publications

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Role of Gastric Electrical Stimulation in the Treatment of Gastroparesis

Robotic Setup Promises Consistent Effects of Multilocular Gastrointestinal Electrical Stimulation: First Results of a Porcine Study

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