Gastric Electrical Stimulation With Parameters for Gastroparesis Enhances Gastric Accommodation and Alleviates Distention-Induced Symptoms in Dogs

Abstract

Gastric electrical stimulation (GES) improves symptoms in patients with gastroparesis. We sought to determine if stimulation at fundus with parameters used for gastroparesis could affect gastric accommodation and distention-induced symptoms in dogs. Nine dogs were implanted with a gastric cannula at the anterior stomach and 1 pair of stimulation electrodes in the fundus. Assessment of gastric accommodation and a series of gastric distention were performed using a barostat. Stimulation parameters were of short pulse trains of 14 Hz, 5 mA, 0.3 ms, and 0.1 s on, 5 s off. GES at fundus significantly decreased fasting gastric tone. Fasting gastric volume was significantly increased from 56.3+/-10.4 mL at baseline to 102.4+/-23.1 mL with stimulation (P=.011). Postprandial gastric accommodation was significantly enhanced with stimulation. The extent of accommodation increased from 249.3+/-39.9 mL in the control session to 325.8+/-25.1 mL with stimulation (P=.011). Symptom scores induced by balloon distention of the stomach were significantly lower during stimulation in comparison with those of baseline (P=.016). In conclusion, GES with parameters for gastroparesis enhances postprandial gastric accommodation and reduces visceral perception in normal dogs. This effect, if seen also in humans, may explain in part the symptomatic improvement associated with GES therapy in patients with gastroparesis.

Cisplatin-Induced Gastric Dysrhythmia and Emesis in Dogs and Possible Role of Gastric Electrical Stimulation

“…To the best of our knowledge, no previous studies have reported the application of GES in the treatment of emetic responses induced by cisplatin. However, previous studies in our laboratory have shown that GES with short pulses improved the symptoms of nausea and vomiting in patients with gastroparesis, or vasopressininduced emetic responses in dogs, with no or minimal effect on gastric motility [17,20,21]. The data obtained in our study are in agreement with the previous findings.…”

“…These include long-pulse stimulation (pulse width in milliseconds), shortpulse stimulation (pulse width in microseconds) and stimulation with trains of pulses instead of repetitive single pulses. It seems that gastric electrical stimulation (GES) with long pulses is capable of normalizing gastric dysrhythmia and pacing gastric slow waves [12][13][14][15][16], whereas stimulation with short pulses is able to reduce nausea and vomiting [17][18][19][20][21].Several studies have shown that GES using an implantable device, called the Enterra Ò Therapy, produces a significant and sustained improvement in symptoms of vomiting and nausea and in nutritional status in most patients with intractable symptomatic gastroparesis or drug-refractory diabetes [18,19,[22][23][24].However, it is unknown whether this special method of GES is effective in reducing chemotherapy-induced emetic symptoms.…”

Systematic review: applications and future of gastric electrical stimulation

“…A recent canine study using GES of short pulses or the so-called Enterra Therapy (Medtronic, Minneapolis, MN, USA) (repetitive trains of two short pulses with a pulse frequency of 14 Hz and width of about 300 ls, it could be considered as trains of short pulses) showed a slight but significant reduction of fundic tone and enhancement of postprandial fundic relaxation accompanied by an improvement in gastric distention-induced symptoms in dogs. 45 However, more studies are needed to confirm these findings. Gastric electrical stimulation with long pulses is capable of altering gastric (both fundic and antral) tone substantially in dogs.…”

“…The Enterra Therapy does not alter gastric slow waves 27,36 but may reduce gastric tone and thus improve gastric accommodation as reported in a canine study. 45 Not much information is available regarding the effect of the Enterra Therapy on visceral hypersensitivity. However, two recent preliminary studies in humans seem to suggest a potential role of the therapy in altering visceral hypersensitivity.…”

537 Long-Term Effects of Gastric Stimulation on Gastric Electrical Physiology

“…This is frequently impairment in gastoparetic patients and has been shown to improve following GES therapy. 15,[34][35][36][37] However, this phenomenon is likely only an explanation for symptomatic reduction and probably does not describe the improvement in baseline gastric frequency.…”