Gastric Electrical Stimulation with the Enterra System: A Systematic Review

Abstract

Background. Gastric electrical stimulation (GES) is a surgically implanted treatment option for refractory gastroparesis. Aim. To systematically appraise the current evidence for the use of gastric electrical stimulation and suggest a method of standardisation of assessment and follow-up in these patients. Methods. A systematic review of PubMed, Web of Science, DISCOVER, and Cochrane Library was conducted using the keywords including gastric electrical stimulation, gastroparesis, nausea, and vomiting and neuromodulation, stomach, central nervous system, gastric pacing, electrical stimulation, and gastrointestinal. Results. 1139 potentially relevant articles were identified, of which 21 met the inclusion criteria and were included. The quality of studies was variable. There was a variation in outcome measures and follow-up methodology. Included studies suggested significant reductions in symptom severity reporting over the study period, but improvements in gastric emptying time were variable and rarely correlated with symptom improvement. Conclusion. The evidence in support of gastric electrical stimulation is limited and heterogeneous in quality. While current evidence has shown a degree of efficacy in these patients, high-quality, large clinical trials are needed to establish the efficacy of this therapy and to identify the patients for whom this therapy is inappropriate. A consensus view on essential preoperative assessment and postoperative measurement is needed.

G‐POEM with antro‐pyloromyotomy for the treatment of refractory gastroparesis: mid‐term follow‐up and factors predicting outcome

“…The median time of follow‐up was 10 months±6.4, with 26/29 patients (89.6%) followed up for 6 months or more. There was only one delayed adverse event: one patient had recurrence of symptoms due to a prepyloric fibrotic relative stenosis due to scar tissue at the level of the tunnel, which was successfully treated by incision using an Insulated Tip knife (Olympus, Tokyo, Japan) with immediate clinical improvement.…”

“…The surgical laparoscopic pyloroplasty appeared efficacious but remained technically complicated and risky for a functional disease . More recently, gastric electrical stimulation was evaluated in several randomised studies, although, the outcomes in terms of efficacy were disappointing and essentially focused on chronic vomiting symptoms …”

Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

“…The surgery options include implantation of gastric stimulators, Roux-en-Y gastric bypass, subtotal gastrectomy, gastrostomy, jejunostomy and pyloric interventions such as pyloromyotomy and pyloroplasty [6,32]. However, gastric electrical stimulation has often been considered first line in the treatment of medically refractory patients with the best level of evidence [33].…”

Diabetic gastroparesis - from diagnosis to gastric electrical stimulation treatment

“…Enterra (Medtronic, Minneapolis, MN, USA) Therapy, is currently the only GES principal method suitable for human implantation 25 . It delivers impulses at high frequency/low energy (short pulses) at around 12 pulses per minute through pacemaker and consequently stimulates the gastric emptying.…”