Temporary gastric neuromodulation for intractable nausea and vomiting

Abstract

INTRODUCTION Gastric neuromodulation (GNM) has been advocated for the treatment of drug refractory gastroparesis or persistent nausea and vomiting in the absence of a mechanical bowel obstruction. There is, however, little in the way of objective data to support its use, particularly with regards to its effects on gastric emptying. METHODS Six patients (male-to-female ratio: 4:2, mean age: 49 years, range: 44–57 years) underwent the GNM between April and August 2010. Three patients had confirmed slow gastrointestinal transit. Aetiology included previous gastric surgery in two, diabetes in one and idiopathic nausea and vomiting in three patients. GNM pacing wires were placed endoscopically and left in situ for seven days. Pa-tients underwent gastric scintigraphy before and 24 hours after the commencement of GNM. Total gastroparesis symptom scores (TSS), weekly vomiting frequency scores (VFS), health-related quality of life (using the SF-12® questionnaire), gastric emptying, nutri-tional status and weight were compared before and after GNM. RESULTS TSS improved after GNM in comparison with baseline data. VFS improved in three of four symptomatic patients. The SF-12® physical composite score improved in four patients (27.5 vs 34.3) and the mental composite score improved in five patients (34.9 vs 35.9). All patients reported an improvement in oral intake. A significant weight gain (mean: 1kg, range: 0.3–2.4kg) was observed over seven days. Gastric emptying half-time improved in four patients. CONCLUSIONS GNM improved upper gastrointestinal symptoms, quality of life and nutritional status in patients with intractable nausea and vomiting. GNM merits further investigation.

Gastric Electrical Stimulation with the Enterra System: A Systematic Review

“…However, pyloroplasty is associated with significant adverse events such as dumping syndrome, and given the poor correlation with gastric emptying and quality of life the authors would not advocate this approach [ 38 ]. Additionally, temporary or transoesophageal GES has been investigated as a potential method for a less invasive trial prior to permanent GES insertion, with mixed results [ 34 , 39 ]. A final point of note is that the device has many potential settings, including adjustments to frequency, time spent ON or OFF, and Hertz.…”