Temporary Endoscopic Stimulation in Gastroparesis-like Syndrome

Abstract

Background/AimsGastroparesis-like syndrome (GLS) is defined as gastroparesis-like symptoms with normal gastric scintigraphy. While the efficacy of gastric electrical stimulation (GES) in gastroparesis is well known, the utility of GES in GLS is largely unknown. Our aim was to clarify the role of GES in GLS. We implanted consecutive patients with symptoms of gastroparesis with temporary gastric electrical stimulation and observed changes in gastric scintigraphy and total symptom score. MethodsFive hundred and fifty-one patients suffering from symptoms of gastroparesis (nausea, vomiting, bloating/distension, anorexia/early satiety, and abdominal pain) with negative endoscopy underwent gastric scintigraphy with analysis of 1) solid radionuclide gastric emptying at 1, 2, and 4 hours (% remaining); 2) area under the gastric emptying curve (AUC) at 1, 2, and 4 hours; and 3) total gastric emptying test (GET) (the sum of 1, 2, and 4 hour values). Patients were stratified into: delayed gastric emptying, normal gastric emptying, and rapid gastric emptying (Appendix). Of the 551 patients in the larger cohort, 379 had implantation of temporary gastric electrical stimulation (tGES). Gastrointestinal symptoms and gastric emptying were compared pre and post tGES implantation. ResultsAfter tGES, 2 hour gastric retention decreased (P ＜ 0.01) for the delayed patients, and increased (P ＜ 0.001) for normal and rapid patients. These changes were accompanied by improvements (P ＜ 0.001) in vomiting, nausea, and total symptom scores in all 3 subgroups.

Gastroparesis syndromes: Response to electrical stimulation

“…Temporary gastric electrical stimulation (temp GES) was performed as previously described in patients who were NPO (nothing by mouth) and with either monitored anesthesia care (MAC) or general anesthesia support, where routine upper endoscopy was performed. During endoscopy two electrodes were placed, one in proximal stomach, targeting the area just distal to the fundus, and one more distally near the body‐antral junction proximal to the angularis.…”

“…Temporary gastric electrical stimulation (temp GES) was performed as previously described 13,14 in patients who were NPO (nothing by mouth) and with either monitored anesthesia care (MAC) or general anesthesia support, where routine upper endoscopy was performed.…”

Functional Emesis

“…A study performed by Singh et al [46] analyzed the effects of temporary gastric electrical stimulation (tGES) in patients with GLS. Total symptom score and scintigraphic parameters were also analyzed.…”

“…Total symptom score and scintigraphic parameters were also analyzed. 551 patients suffering from symptoms of gastroparesis (emesis, nausea, bloating/distension, anorexia/ early satiety, and abdominal pain) with negative endoscopy underwent gastric scintigraphy [46]. The following parameters were recorded: solid radio-nuclide gastric emptying, area under the gastric emptying curve and the total gastric emptying test.…”

Expanding Indications of Gastric Electrical Stimulation

“…6 Fecal incontinence, and constipation can be possible clinical applications using electrical stimulation of the gastrointestinal tract. 7 In this issue of the Journal of Neurogastroenterology and Motility, Singh et al 8 report on the effects of temporary GES in gastroparesis-like syndrome (GLS). The aim of their prospective study was to explore the effects of endoscopy-based temporary GES in patients showing symptoms of gastroparesis with non-delayed gastric emptying.…”