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

Abstract

Gastroparesis or gastric stasis is the delayed transit of the ingested contents through the stomach in the absence of mechanical obstruction. It can have multiple etiologies, most commonly idiopathic (ID) and diabetic (DM). Gastroparesis can cause significant distress to patients as it leads to symptoms like intractable nausea and vomiting, weight loss, abdominal bloating, early satiety, etc. The pathogenesis is mainly thought to be due to the dysfunction of the gastric pacemaker cells, i.e., interstitial cells of Cajal (ICC), and their interaction with the other gastric motor function regulatory components. There are several proposed treatment options for gastroparesis. Despite that, most patients remain refractory to medical treatment and require additional interventions for symptomatic relief. One such intervention is gastric electrical stimulation or gastric pacemaker, which aids in improving gastric motility. We have searched PubMed, PubMed Central (PMC), Medline, Science Direct, and Google Scholar for articles pertaining to the use of gastric electrical stimulation in gastroparesis published in the last 10 years. The keywords used include "gastroparesis", "gastric stasis", "gastric pacemaker'', "gastric electrical stimulation", "nausea", "vomiting", "abdominal bloating", "gastric neuromodulation". We have finally included twelve studies that were the most relevant to our research question and met the quality assessment criteria. Exclusion criteria consisted of pediatric population studies, studies conducted on animals, books, and grey literature. Overall, these twelve studies helped evaluate the impact of gastric pacemakers on symptoms of gastroparesis like nausea, vomiting, weight loss, abdominal bloating, and quality of life. We found that most studies favored gastric pacemakers, improving the incidence of nausea and vomiting in patients with gastroparesis. There was a marked improvement in the BMI as well. On the other hand, most open-labeled studies showed improved quality of life and Gastroparesis Cardinal Symptom Index (GCSI) scores, while randomized controlled trials and meta-analyses did not reflect the same result. In addition, some other parameters improved with gastric pacemakers, Inflammatory markers, insulin levels (especially in diabetics), and the number of hospitalizations. In conclusion, gastric pacemaker is a potential treatment option for patients with medically refractory gastroparesis. As noted from the results of our study, nausea/vomiting, weight loss, and overall GCSI scores have shown marked improvement with gastric electrical stimulation (GES). Nevertheless, more extensive research is needed to understand better the full extent of this device’s use as a viable treatment option for patients suffering from gastroparesis.

Systematic review on sleeve gastrectomy or Roux-en-Y gastric bypass surgery for refractory gastroparesis

“…GES by a gastric pacemaker has several electrophysiologic effects and has been shown to reduce symptoms such as nausea and vomiting in open-label studies and in a recent randomized trial [38]. However randomized controlled trials did not demonstrate a significant benefit of GES over placebo in terms of gastric emptying and quality of life [8,38,39]. Subsequently, open or laparoscopic pyloroplasty/pyloromyotomy has shown improvement in symptoms [9].…”

“…Conventional therapy includes dietary advice with nutritional support, use of antiemetics or prokinetics, and when these are not effective, a period of gastric rest with short-or longer-term enteral nutrition [4]. If these therapies are not successful, gastric electrical stimulation (GES) by gastric pacemaker and pyloric interventions such as pyloroplasty and pyloromyotomy (either laparoscopic, open, or gastric peroral endoscopic myotomy [G-POEM]) have been introduced in recent years as treatment options for refractory gastroparesis [5][6][7][8][9]. Several systematic reviews report promising results on the efficacy of G-POEM [5,6].…”

Nutritional therapy for gastroparesis

“…More studies are needed to evaluate the effect of GES in patients with gastroparesis. [29,30] 10. Surgical treatment If the diagnosis of gastroparesis is clear, patients should be treated with nonsurgical methods.…”

Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis

“…Although these medications help reduce patients' GI discomfort and promote increased nutrient intake, they also have some negative side effects and are simple to relapse following drug discontinuation[ 17 - 19 ]. Some patients with DGP are also treated with alternative strategies (endoscopy, electrical stimulation, or surgery), but with greater financial burden[ 20 - 23 ]. Traditional Chinese medicine (TCM) has a history of more than 2000 years in the treatment of GI diseases, which is considered a complementary and alternative therapy for patients with DGP[ 24 - 27 ].…”