Efficacy of gastric electrical stimulation in intractable nausea and vomiting at 10 years: A retrospective analysis of prospectively collected data

Abstract

Background: Gastric electrical simulation has been shown to relieve nausea and vomiting in medically refractory patients. Efficacy of gastric electrical stimulation has been reported mostly in short-term studies, but none has evaluated its efficacy beyond 10 years after implantation. Methods: Patients implanted at our center for medically refractory severe and chronic nausea and/or vomiting were evaluated before and over 10 years after implantation using symptomatic scale and quality of life (GIQLI) score. Improvement was defined as a reduction of more than 50% in vomiting frequency. Key Results: A total of 50 patients were implanted from January 1998 to December 2009. Among them, 7 were explanted due to a lack of efficacy and/or side effects, 2 died, and 4 were lost to follow-up. Mean follow-up was 10.5 ± 3.7 years. In intention-to-treat analysis, 27/50 (54%) patients reported an improvement. Beyond 10 years, an improvement in early satiety (3.05 vs 1.76, <0.001), bloating (2.51 vs 1.70, P = .012), nausea (2.46 vs 1.35, P = .001), and vomiting (3.35 vs 1.49 P < .001) scores were observed. Quality of life improved over 10 years (GIQLI score: 69.7 vs. 86.4, P = .005) and body mass index (BMI: 23.4 vs. 26.2 kg/m 2 ; P = .048). Conclusions and Inferences: Gastric electrical simulation is effective in the long-term in patients with medically refractory nausea and vomiting, with an efficacy of 54% at 10 years on an intention-to-treat analysis. Other long-term observational studies are warranted to confirm these results.

Gastric Electrical Stimulation: Role and Clinical Impact on Chronic Nausea and Vomiting

“…A meta-analysis including up to 600 patients showed an improvement in total symptom severity score, nausea, vomiting, early satiety, and loss of appetite ( Chu et al, 2012 ). Long-term studies evidenced that clinical efficacy was seen even after 5 and 10 years of follow-up in more than 50% of patients in an intention to treat follow-up ( McCallum et al, 2011 ; Gourcerol et al, 2012 ; Hedjoudje et al, 2020 ). GES was shown to reduce hospitalization requirements, nutritional status, and HbA1c ( Abell et al, 2003a ).…”

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

“…In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as gastric peroral endoscopic myotomy (G-POEM), may help address refractory. Endoscopic pyloromyotomy appears to be effective in the short term, especially for nausea and vomiting, but further study is needed to accurately identify the subset of gastroparesis patients who have pyloric dysfunction, and long-term results must be assessed [ 15 , 4 ] (Figure 5 ).…”

“…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 ]. In another study conducted on 13 patients by Laine et al showed that before implantation, 13 had severe nausea, 11 had severe vomiting.…”

“…Abdominal bloating, early satiety, and slow gastric emptying symptoms- Impact of GES on these symptoms was evaluated in a study published by Hedjoudje et al In 2020 with a total of 50 patients who were implanted with Gastric pacemakers from January 1998 to December 2009 demonstrated that beyond ten years, there is an improvement in early satiety (3.05 vs. 1.76, p <0.001), bloating (2.51 in comparison to 1.70, P =.012) [ 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.…”

“…According to this study, 11 patients (79%) gained a median of 5.1 kg in weight (P < 0.01) [ 21 ]. Another study with positive results is a retrospective single-center study with 50 participants showing improved BMI post gastric pacemaker implantation (23.40 vs. 26.46, p= 0.048) [ 15 ].…”