Gastric Electrical Stimulation for Gastroparesis

Abstract

Gastric electrical stimulation (GES) for gastroparesis has been in use for more than a decade. Multiple publications, consisting almost entirely of open label single center studies, reported a beneficial effect on symptoms, quality of life and nutritional status. Some predictors of better response to GES have been lately identified, primarily diabetic etiology and nausea and vomiting as the predominant symptoms. However, individual response to GES remains difficult to predict. The mechanism of action of GES remains poorly understood. Stimulation parameters approved in clinical practice do not regulate gastric slow wave activity and have inconsistent effect on gastric emptying. Despite such limitations, gastric electrical stimulation remains a helpful intervention in some patients with severe gastroparesis who fail to respond to medical therapy.

Surgical Approaches to Treatment of Gastroparesis

“…These parameters can entrain slow waves, reverse dysrhythmias, and, hence, accelerate gastric emptying. [10][11][12][13] (2) On the other hand, short-pulse low-energy GES at frequencies higher than physiologic is termed neurostimulation, and may alleviate gastroparetic symptoms, specifically nausea and vomiting, without a meaningful improvement in gastric emptying or changing the underlying slow-wave rhythm pattern. 14,15 Hence, the predicted outcome or goals of GES depend on the parameters of the applied stimulation (Fig.…”

“…This increasing knowledge of gastric electrophysiology inspired, in the late 1990s, a group of scientists and clinicians, such as Qian, Kelly, McCallum, Morison and Familoni, to pursue the potential therapeutic role of gastric pacing and normalization of myoelectrical dysrhythmia. [10][11][12][13] …”

Periprocedural Considerations for Patients with Gastric Electrical Stimulators

“…The pulse generator is typically implanted under the skin in the upper right or left quadrant of the abdomen, but many locations on the anterior abdominal may be used . Leads extend from the pulse generator to the electrodes, which are implanted in the muscularis propria of the greater curvature of the stomach . An external programming device is used to control the stimulation parameters .…”

Expanding Indications of Gastric Electrical Stimulation

“…Unfortunately, an individual's response to temporary GES remains unpredictable. 11 The authors indicated that temporary GES improved nausea, vomiting, and total symptom scores without accelerating gastric emptying. However, they did not consider abdominal pain, another common symptom of gastroparesis, as a parameter after insertion of the temporary GES electrode pair and neurostimulator.…”