Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management

Shanker, Aaron; Bashashati, Mohammad; Rezaie, Ali

doi:10.1007/s11894-020-00803-0

Cited by 11 publications

(5 citation statements)

References 43 publications

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“…111 High-frequency GES may modulate symptoms and particularly vomiting via vagal pathways, representing a surgical option for patients with refractory gastroparesis. 115,116 However, GES operates with neural parameters, and does not directly modulate gastric conduction patterns. 117,118 Radiofrequency ablation presents another emerging approach to normalize slow wave activity.…”

Section: Future Directions: Diagnosis and Therapy Of Gastric Conducti...mentioning

confidence: 99%

The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Carson

Robertson

Wang

et al. 2022

Foregut: The Journal of the American Foregut Society

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Chronic symptoms of gastric dysfunction are common following gastric surgery, but the mechanisms underlying these have remained poorly understood. Disturbances of foregut motility are suspected to play a central role, however knowledge of how these abnormalities manifest and relate to symptoms requires elucidation. Emerging data suggests that abnormalities of the gastric conduction system are a common consequence of gastric surgery and may contribute to dysmotility and post-operative symptoms. This review provides a primer on the gastric conduction system. The normal physiology of the gastric conduction system and factors that influence resilience to surgery are outlined, together with focused discussion on three surgical procedures that impact post-operative gastric dysfunction: resection of the gastric pacemaker, resection or bypass of the pylorus, and vagotomy. The mechanistic pathways that underpin the clinical effects of these procedures are discussed. Future horizons are also evaluated, including newly established body surface gastric mapping techniques that provide a non-invasive method to detect changes in the gastric conduction system and relate these to symptoms in postoperative patients, with the goal of developing targeted interventions for prevention and therapy.

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Section: Future Directions: Diagnosis and Therapy Of Gastric Conducti...mentioning

confidence: 99%

The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Carson

Robertson

Wang

et al. 2022

Foregut: The Journal of the American Foregut Society

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show abstract

“…Gastroparesis is often difficult to diagnose as symptoms are nonspecific and can mimic structural disorders. Initial non-invasive management of gastroparesis includes lifestyle modifications [8] followed by pharmaceutical agents. If no improvement is seen, an invasive option is a Gastric Electric Stimulator (GES).…”

Section: Discussionmentioning

confidence: 99%

“…It is essential to have a coordinated gastric peristaltic contraction which subsequently propels and empties ingested food [14]. In a recent study, Shanker notes that in gastroparesis, there is a depletion of ICCs throughout the stomach, more prominently in the pylorus [8]. This prevents the series of complex events that require coordination of the parasympathetic and sympathetic nervous systems, neurons, and pacemaker cells within the stomach and intestine, along with the smooth muscle cells of the gut [15].…”

Section: Discussionmentioning

confidence: 99%

Wandering Gastric Leads: A Rare Complication of a New Treatment Modality of Gastroparesis

Choday¹,

Nakka²,

Wassel³

2022

J Clin Images Med Case Rep

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Gastroparesis is a chronic disease characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. First-line treatment consists of an antiemetic agent with a pro-motility drug. However, in a 12-year prospective study by Jones et al., they found that symptoms of gastroparesis in diabetic patients often persisted despite adequate glycemic control and optimal medical management. Therefore, the Gastric Electric Stimulator (GES) was made for refractory diabetic gastroparesis, defined by failure of 1 year of medical therapy. [1]. However, despite the benefit of the GES, limited studies are commenting on the potential complications.

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“…Gastric electrical stimulation offers a variety of potential benefits, including synchronization of intrinsic gastric electrical activity, evoking propagating contractions, and alleviating symptomatology in individuals with gastroparesis, depending on stimulus settings and stimulation locations. Extra-intestinal effects of gastric stimulation parameters include alterations in systemic hormonal and autonomic neural activity, as well as modification of afferent nerve pathways projecting to the central nervous system, which might be significant mechanisms of action [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Rajamanuri

Mannava

Chhabra

et al. 2021

Cureus

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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.

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Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management

Cited by 11 publications

References 43 publications

The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Wandering Gastric Leads: A Rare Complication of a New Treatment Modality of Gastroparesis

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

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