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

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Background Both gastric electrical stimulation (GES) and gastric‐peroral endoscopic myotomy (G‐POEM) can be offered to patients with gastroparesis and predominant nausea and vomiting. The study's aim was to compare GES and G‐POEM efficacy on nausea and vomiting scores in patients with gastroparesis. Methods Two multicenter cohorts of patients with medically refractory gastroparesis with predominant nausea and vomiting (defined as a score >2 on nausea and vomiting subscale that varied from 0 to 4) were treated either with GES (n = 34) or G‐POEM (n = 30) and were followed for 24 months (M). Clinical response was defined as a decrease of ≥1 point in nausea and vomiting subscale without premature exclusion due to switch from one to the other technique before M24. Changes in symptomatic scales and quality of life were also monitored. Key Results Patients from both groups were comparable although the mean score of nausea and vomiting subscale was higher in GES (3.0) compared to G‐POEM group (2.6; p = 0.01). At M24, clinical response was achieved in 21/34 (61.7%) patients with GES and in 21/30 (70.0%; p = 0.60) patients with G‐POEM. Mean scores of nausea and vomiting subscale decreased at M24 in both GES (from 3.0 to 1.6; p < 0.001) and G‐POEM (from 2.6 to 1.2; p < 0.001) groups, although there was no difference between groups (difference adjusted from baseline: −0.28 [−0.77; 0.19]; p = 0.24). Likewise, symptomatic and quality of life scores improved at M24 in both groups, without difference according to treatment group. Conclusions and Inferences At M24, we did not observe significant difference in efficacy of GES and G‐POEM in medically refractory gastroparesis with predominant nausea and vomiting.

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Gastric electrical stimulation versus per‐oral pyloromyotomy for the treatment of nausea and vomiting associated with gastroparesis: An observational study of two cohorts

Gourcerol

Gonzalez²,

Bonaz

et al. 2023

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“…To date, the most validated alternative treatment to G‐POEM in severe refractory gastroparesis is gastric electrical stimulation (GES). 111 In randomized controlled trials, GES has shown a significant reduction of nausea and vomiting in patients with refractory gastroparesis. 112 There are no criteria to guide the choice of treatment, which therefore depends on the local possibilities and experience.…”

Section: Alternative Treatments and Future Directionsmentioning

confidence: 99%

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Soliman

Gourcerol

2023

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Gastroparesis is defined as delayed gastric emptying (GE) of solid food in the absence of mechanical obstruction. 1 Cardinal symptoms include nausea, vomiting, gastric fullness, early satiety, bloating, and abdominal pain/discomfort. 2 These symptoms can overlap with those of functional dyspepsia, but gastroparesis has to be confirmed by an objective measurement of GE, either by scintigraphy, or by 13 Coctanoic acid breath test. The prevalence of diagnosed gastroparesis has been evaluated in the United States at 0.24% of the population. 3 Recent epidemiological data from the United Kingdom confirm a similar prevalence of 0.13% in Europe based on the diagnostic code, although the disease appears to be underdiagnosed. 4 Gastroparesis leads to an economic burden, evaluated between US$4000 and US$9000 per patient per year in a recent study. 5 Moreover, delayed GE has been associated with increased mortality, independently of age, sex, or the etiology of the disease. 6 The first-line treatment relies on dietary modification and medical treatment, with prokinetic drugs such as metoclopramide. 7,8 However, the efficacy of medical treatment is limited, and up to 40% of patients are considered to be refractory after appropriate treatment. 9 Severe refractory gastroparesis can lead to dehydration, weight loss, and impaired quality of life and could become a challenging condition. 10 Thus, invasive techniques have been developed to improve the symptoms of such patients.Considering the role of pyloric dysfunction in gastroparesis, 11 gastric peroral endoscopic pyloromyotomy (G-POEM) has emerged as an alternative therapeutic technique in patients with refractory gastroparesis. The first human case was described in 2013 by Khashab et al. 12 The technique is based on the principles of peroral endoscopic myotomy of the lower esophageal sphincter, used to treat achalasia. Since then, cohort studies have assessed the clinical efficacy and the safety of G-POEM in refractory gastroparesis.This review aims to detail the role of the pylorus in the pathophysiology of gastroparesis, and then to report the efficacy, modalities, and the place of G-POEM, based on the results of published studies.

“…1 Gastric electrical stimulation (GES) has proven to be effective in the treatment of refractory chronic nausea and vomiting. 6 This efficacy has been proven in patients with normal and delayed gastric emptying. 7 In 2019, a multicenter cohort study of 319 gastroparesis patients concluded a significant improvement in nausea and vomiting within 48 weeks after the implantation of GES.…”

Section: Introductionmentioning

confidence: 99%

“…10 The battery life is 5 to 10 years, but it can be replaced if necessary. 6 Therefore, many female patients remain with an active GES device for many years.…”

Section: Introductionmentioning

confidence: 99%

Gastric electrical stimulation is safe during pregnancy and delivery: Results from a French cohort

Soliman

Schalla

Coffin

et al. 2023

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BackgroundGastric electrical stimulation (GES) is an effective therapy in medically refractory chronic nausea and vomiting. GES is assumed to be a contraindication for pregnancy. We examined the safety of GES during pregnancy and its clinical impact on vomiting symptoms.MethodsA retrospective study was performed in two tertiary centers including all female patients of childbearing age implanted with GES. Patients without pregnancy while on GES were asked about their desire and concerns about pregnancy. Patients who were pregnant while on GES therapy were interviewed about the course of the pregnancy and labor, as well as the health of the children.Key ResultsAmong 91 patients implanted at childbearing age, 54 patients without pregnancy answered the questionnaire. Nine patients (16.7%) reported a desire for pregnancy and five patients (7.4%) reported worries about the safety of GES during pregnancy. Sixteen pregnancies were reported in 10 patients. All pregnancies ended in a live birth with premature birth in 12 pregnancies (75.0%). No health concern was currently noted in these children. No severe GES‐related complications occurred during pregnancy with only pain at the implantation site reported during 3 pregnancies (18.8%). The severity and frequency of nausea and vomiting significantly increased during the first trimester (p = 0.04 and p = 0.005, respectively) and decreased after the delivery, becoming lower than before the pregnancy (p = 0.044 and p = 0.011, respectively).Conclusion & InferencesPatients are concerned regarding pregnancy while being treated with GES. No serious maternal or fetal complications related to GES were noted in our cohort.