Efficacy of Gastric Electrical Stimulation for Gastroparesis: US/European Comparison

Abstract

BackgroundGastric electrical stimulation (GES) is used in both the US and Europe, but little research has investigated the demographics of gastroparesis patients receiving GES by geographic location.MethodsWe compared data from 380 patients, 296 female and 84 males, mean age 42 years, 246 idiopathic (ID), 107 diabetic (DM), and 27 post-surgical (PS). The statistical significance was calculated by Chi-square test and a P-value obtained for ID, DM, and PS. The statistical significance was calculated by Fischer exact test and a P-value obtained comparing male vs. female.ResultsEuropean centers had 61 GES patients compared to 319 from the US. In Europe, 100% of patients had gastric emptying test (GET) values available; in the US, it was 75% of patients. European centers had more DM patients (59%) than the US (22%), and a smaller proportion of ID patients (25%) than the US (72%). There was a statistical difference between the causes of gastroparesis in the patients receiving GES (P-value < 0.00001). There was also significant difference in the gender of the patients receiving GES, with a greater proportion of women in the US (P value = 0.0023).ConclusionsComparing GES in US vs. Europe demonstrated significant differences in gastroparesis demographics and percentage of patients with GET data. After analyzing the previously discussed results and reviewing recent updates in evidence-based medicine guidelines, the discrepancy and variance in patient populations in the US and Europe emphasizes the need for a database that allows better analysis and treatment of gastroparesis patients worldwide including stimulation therapies.

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

“…GES or Enterra Therapy on the other hand for treating nausea and vomiting in gastroparesis 7 has not been very promising on overall symptoms of gastroparesis or gastric emptying. [8][9][10] All the above-mentioned treatment approaches due to their natures can address only a fraction of overall symptoms/problems and somehow exacerbate the other symptoms. As we know, regulation of gastric motility needs intrinsic contractions/relaxations of GI muscles under the influence of extrinsic afferents/efferents of the autonomic nervous system.…”

“…Gastric electrical stimulation (Enterra Therapy) has been approved for humanitarian use in treating nausea and vomiting in gastroparesis, 7 however reports of efficacy have varied among different centers and some have failed to show any promising effects on overall symptoms of gastroparesis or gastric emptying. [8][9][10] On the other hand, while a number of prokinetic medications (such as cisapride) were developed to restore normal gastrointestinal motility, they have been withdrawn from the market due to their unfavorable cardiovascular safety. 11 Noteworthy is that treating overall symptoms of gastroparesis is another dilemma.…”

Epidemiology and outcomes of gastroparesis, as documented in general practice records, in the United Kingdom

“…In the previous study in Olmsted County, 49% of patients were deemed to have idiopathic gastroparesis versus 25% of patients who were recorded as having diabetic gastroparesis. 7 This discrepancy in recorded disease aetiologies for patients with gastroparesis between the UK and the USA has been noted previously, 47 and again suggests substantial differences in the investigation of upper GI symptoms, disease awareness, and labelling of the condition between the UK and the USA. Among the 223 patients who were judged as having drug-induced gastroparesis, the third most common cause in CPRD, 152 (amounting to 13% of the entire study population) were using opioid analgesic.…”

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

“…From the latest available data, approximately 18,000 GES devices have been implanted worldwide with a current device system cost of about $13,500. Of those, about 90% are in the US and of those, approximately 50% were implanted in 20 US centers. As detailed in this report, GES is currently more likely to be given to patients with more severe drug‐refractory gastroparesis symptoms.…”