Endoscopic aspects of temporary gastric electrical stimulator lead placement in patients with gastroparesis and gastroparesis-like syndromes

Abstract

Gastric electrical stimulation (GES) is an accepted form of therapy for gastroparesis and is considered for compassionate therapy in patients with refractory nausea and vomiting. The U. S. Food and Drug Administration has approved GES for treatment of drug-refractory idiopathic gastroparesis and diabetic gastroparesis, but it has also been used off label for related conditions. Although GES has been shown to improve the frequency of nausea and vomiting in patients with idiopathic and diabetic gastroparesis, it has also shown benefit in patients affected by the symptoms of gastroparesis, ie, nausea, vomiting, and abdominal pain, but with nondelayed gastric emptying, referred to as gastroparesis-like syndrome or unexplained nausea and vomiting. Because not all patients with gastroparesis and gastroparesis-like syndrome benefit from GES, a trial of temporary gastric stimulation (Fig. 1) can help determine those who would benefit from placement of a permanent gastric stimulator, which requires surgery. The techniques for endoscopic and surgical placement of gastric electrical stimulators are not widely known or performed. The purpose of this video (Video 1, available online at www.VideoGIE.org). is to highlight the important aspects of temporary gastric electrical stimulator lead placement with advanced endoscopic techniques, which may then lead to the surgical placement of a permanent gastric stimulator.

Role of Gastric Electrical Stimulation in the Treatment of Gastroparesis

“…This FDA approval, for the current Enterra system (Medtronic, Inc.), allows for use of higher than nominal energies of stimulation. In addition, a trial of temporary gastric stimulation may help determine patients who would benefit from surgical placement of a permanent gastric stimulator [3]. This article reviews some of the new findings on the pathophysiology of gastroparesis syndromes and mechanisms of action of GES, while focusing on one particular therapy-GI neuromodulation via low and medium energy gastric electrical stimulation (GES).…”

Gastroparesis syndromes: Response to electrical stimulation

“…An additional drawback is the temporary endoscopic GES is not performed at a great number of centers. However, the number of centers has slowly increased, in part due to the availability of endoscopic videos and other published materials on the techniques of placing electrodes endoscopically …”

“…However, the number of centers has slowly increased, in part due to the availability of endoscopic videos and other published materials on the techniques of placing electrodes endoscopically. 30 An additional factor is the emergence of pyloric therapies for gastroparesis over the last 5 years. 31,32 Although not yet defined, the presence of systemic inflammation might indicate that the occurrence of pyloric dysfunction, including fibrosis, and resultant delayed gastric emptying, might be a secondary consequence of inflammation at the local GI tract level.…”

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

“…18,46 New lines of research are emerging such as temporary gastric stimulation that can help determine those who would benefit from placement of a permanent gastric stimulator and subsequent surgery. 47 Moreover, electrogastrography as low-or high-resolution is a technique for assessing gastric myoelectric activity using cutaneous electrodes to extract spatial parameters of slow-wave propagation. It has been successfully performed to estimate features of the direction and speed of the gastric slow wave in healthy subjects 48. These new tools could help identify the patients most likely to respond to gastric electrical stimulation.…”