Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long‐term follow‐up

Abell, Thomas L.; Lou, Jingjing; Tabbaa, Mumtaz; Batista, Oscar; Malinowski, Scott S.; Al-Juburi, Amar

doi:10.1177/0148607103027004277

Cited by 96 publications

(91 citation statements)

References 7 publications

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“…Results of other studies suggest favorable responses, if they are to occur, will take place within the initial 3-6 months, although this needs further study. In an abstract with long-term patient follow-up, investigators observed 26% and 44% reductions in nausea and vomiting, respectively, persisting for up to 10 years [11].…”

Section: Discussionmentioning

confidence: 97%

“…There have been other studies reporting on an individual institution's experience with Enterra GES [4][5][6][10][11][12]. In two single center studies, electrical stimulation has been reported to improve nutritional status, limit the need for prokinetic and antiemetic medications, and reduce the need for hospitalizations and supplemental nutrition [4,10].…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

et al. 2007

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The objectives of this study were to determine the clinical response to Enterra gastric electric stimulation (GES) in patients with refractory gastroparesis and to determine factors associated with a favorable response.Methods-This study was conducted in patients undergoing Enterra GES for refractory gastroparesis. Symptoms were scored before and after GES implantation using the Gastroparesis Cardinal Symptom Index (GCSI) with additional questions about abdominal pain and global clinical response.Results-During an 18-month period, 29 patients underwent GES implantation. Follow-up data were available for 28 patients, with average follow-up of 148 days. At follow-up, 14 of 28 patients felt improved, 8 remained the same, and 6 worsened. The overall GCSI significantly decreased with improvement in the nausea/vomiting sub-score and the post-prandial subscore, but no improvement in the bloating subscore or abdominal pain. The decrease in GCSI was greater for diabetic patients than idiopathic patients. Patients with main symptom of nausea/vomiting had a greater improvement than patients with the main symptom of abdominal pain. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript narcotic analgesics at the time of implant had a poorer response compared to patients who were not.Conclusions-GES resulted in clinical improvement in 50% of patients with refractory gastroparesis. Three clinical parameters were associated with a favorable clinical response: (1) diabetic rather than idiopathic gastroparesis, (2) nausea/vomiting rather than abdominal pain as the primary symptom, and (3) independence from narcotic analgesics prior to stimulator implantation. Knowledge of these three factors may allow improved patient selection for GES.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

et al. 2007

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“…Near-completion gastrectomy (NCG) has proved useful in small series of patients [21] , but data on longterm follow-up has been lacking. Gastric electrical stimulation can be of value in the management of gastroparesis [22][23][24] , in which the patients with PGS received continuous highfrequency/low-energy gastric electrical stimulation via electrodes deposited in the muscular wall of the antrum and connected to a neurostimulator in an abdominal wall pocket. This method produced entrainment of the intrinsic slow wave and promoted contractions in phase III with the normal slow wave.…”

Section: Discussionmentioning

confidence: 99%

Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer

Dong

Li²,

Guan³

et al. 2004

WJG

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AIM:To explore the etiology, pathogenesis, diagnosis, and treatment of postsurgical gastroparesis syndrome (PGS) after pancreatic cancer cryotherapy (PCC) or pancreaticoduodenectomy (PD), and to analyze the correlation between the multiple factors and PGS caused by the operations. METHODS:Clinical data of 210 patients undergoing PD and 46 undergoing PCC were analyzed retrospectively. RESULTS:There were 31 (67%, 31/46) patients suffering PGS in PCC group, including 29 with pancreatic head and uncinate tumors and 2 with pancreatic body and tail tumors. Ten patients (4.8%, 10/210) developed PGS in PD group, which had a significantly lower incidence of PGS than PCC group (χ = 145, P<0.001). In PCC group, 9 patients with PGS were managed with non-operative treatment (drugs, diet, nasogastric suction, etc.), and one received reoperation at the 16th day, but the symptoms were not relieved. In PD group, all the patients with PGS were managed with non-operative treatment. The PGS in patients undergoing PCC had close association with PCC, tumor location, but not with age, gender, obstructive jaundice, hypoproteinemia, preoperative gastric outlet obstruction and the type and number of gastric biliary tract operations. The mechanisms of PGS caused by PD were similar to those of PGS following gastrectomy. The damage to interstitial cells of Cajal might play a role in the pathogenesis of PGS after PCC, for which multiple factors were possibly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the pancreatico-duodenal regions or reduced circulating levels of motilin.CONCLUSION: PGS after PCC or PD is induced by multiple factors and the exact mechanisms, which might differ between these two operations, remain unknown. Radiography of the upper gastrointestinal tract and gastroscopy are main diagnostic modalities for PGS. Non-operative treatments are effective for PGS, and reoperation should be avoided in patients with PGS caused by PCC. Dong K, Li B, Guan QL, Huang T. Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer.

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“…In one uncontrolled multicenter trial, 35 of 38 patients experienced > 80% reductions in nausea and vomiting which persisted for 2.9-15.6 mo, with an associated 5.5% increase in weight and reduced requirement of supplemental nutrition [123] . Other studies reported similar long-term symptom benefits, which may persist for at least 10 years with improvements in body mass index, serum albumin and glycemic control [124,125] . In the only controlled trial of GES, 33 patients with idiopathic or diabetic gastroparesis completed a 2-mo double-blind, crossover, sham stimulation-controlled phase followed by 12 mo uncontrolled observation, with the device activated [119] .…”

Section: Gesmentioning

confidence: 72%

Gastroparesis: Current diagnostic challenges and management considerations

Waseem¹,

Moshiree²,

Draganov³

2009

WJG

140

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Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician.

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Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long‐term follow‐up

Cited by 96 publications

References 7 publications

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer

Gastroparesis: Current diagnostic challenges and management considerations

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