Role of Gastric Electrical Stimulation in the Treatment of Gastroparesis

Abstract

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.

A Systematic Review of the Therapeutic Role of Gastric Pacemakers in Adults With Gastroparesis

“…GCSI scale was used to analyze the improvement of nausea and vomiting scores, showing that nausea scores dropped from 3.5 at baseline to 1.7 and 2.6 and six weeks and six months, respectively. Similarly, vomiting scores had dropped from 2.4 to 0.6 and 1.8 as published in a review made by Shine et al [ 18 ].…”

“…Nausea and vomiting are the most frequent and bothersome symptoms experienced by patients with gastroparesis. The gastric pacemaker has been shown to help alleviate these symptoms, as described in the studies in our review [ 18 ]. A study conducted between 1998 to 2009 on 50 patients revealed that there was an improvement in nausea (2.46 vs. 1.35, P =.001) and vomiting (3.35 vs. 1.49, P<0.001) [ 15 ].…”

“…According to a review published by Shine et al in 2019, compared to baseline gastric emptying delay, total liquid emptying delay significantly decreased, from 94% at baseline to 52% and 58%, using a temporary and permanent GES, respectively. In addition, baseline total solid emptying delay decreased from 152% to 105% and 100% at six days and six months [ 18 ]. About abdominal pain, in a clinical trial conducted by Lahr et al, patients suffering from severe abdominal pain had improved significantly with both temporary and permanent placement of gastric pacemakers [ 23 ].…”

“…Quality of life- a large, multi-center, randomized, double-blind trial with a crossover consisting of 172 patients also did not show any significant difference in the quality of life among those with GES therapy [ 17 ]. On the other hand, Shine et al published a study in 2019 showing a significant postoperative (implantation of gastric pacemaker) increase of 40.7% and 24.6% (p < 0.05) in quality-of-life scores [ 18 ].…”

“…A substantial postoperative increase in quality-of-life scores of 40.7 percent and 24.6 percent (p 0.05) was observed in a long-term follow-up of 28 patients with GES that focused on nutritional elements of GP syndromes. Changes in overall IDIOMS scores with GES were larger in idiopathic patients (baseline:19.9, temp GES:12.8, perm GES:13.5) than diabetic patients (baseline:19.9, temp GES:12.8, perm GES:13.5) [ 18 ].…”