Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

Abstract

OBJECTIVE -To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. RESEARCH DESIGN AND METHODS-This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA 1c , and adverse events.RESULTS -In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA 1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery.CONCLUSIONS -In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.

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

“…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].…”

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

“…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.…”

Diabetic Gastrointestinal Neuropathy: Elusive Diagnosis and Difficult Treatment

“…The key questions needing answer are which patients are likely to respond, the optimal electrode placement, and the optimal stimulation parameters, none of which had been rigorously evaluated (American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Gastroparesis) [35] and still have not been so far. This is the reason why other experiments have been performed during the last few years, including the one by Lin's group [36] who retrospectively reviewed all patients undergoing GES implantation at the University of Kansas Medical Center (KUMC) from 1998 to 2002, to analyze the effects of GES on symptoms, health-related quality of life (HQOL), nutritional status, GE, and the degree of glucose control in 48 diabetic patients who had medically refractory gastroparesis and at least 12 months of follow-up available.…”