Gastric Stimulation as a Novel Surgical Approach to Treatment of Drug Refractory Gastroparesis at Kansas University Medical Center
Abstracts
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Background: Gastroparesis (GP) is a difficult therapeutic challenge. The presenting complaints include nausea, vomiting, bloating, fullness, early satiety and abdominal pain. Recently, gastric electrical stimulation (GES) has been introduced into the therapeutic armamentarium for patients with GP refractory to pharmacological therapy. The goals of this study were to assess the long-term efficacy, safety of GES, and quality of life (QOL) GP population. Methods: Since 1998, 55 patients from 22 states underwent GS implantation at KUMC. 25 patients have had GES for more than 1 year. 76% were women (mean age=41, 21-66) and 98% were Caucasian, with avg. 6.2 years of gastroparesis. The etiologies of GP were as follows: 39 patients (71%) had diabetic (mean 18.4 yrs of DM), 9 (16%) post-surgical, and 7 (13%) idiopathic gastroparesis. All patients had prolonged gastric retention by scintigraphy at baseline, then 6 and 12 months follow-up. Frequency and severity of nausea and vomiting were evaluated at baseline and during follow-up, using a patient diary. Also, all GI symptoms were assessed using a 5-point scale (0=absent, 4 points=extremely present) and QOL was assessed with SF-36 questionnaire. Study measures included body mass index (BMI) for all patients and HbA1C in diabetics. Two electrodes (Medtronic model 4300) were implanted within the muscularis propria of the greater curvature, 9.5 and 10.5 cm proximally from the pylorus, by laparotomy. Leads were connected to an implantable neurostimulator placed in a subcutaneous pocket in the abdominal wall, in the right upper quadrant. Results: Severity of nausea and vomiting and total symptom score improved significantly at 6 and 12 months of the follow-up (P<.0001). Also, the physical and mental composite scores of QOL improved significantly (P<0.025). BMI at 6 months was changed from 21.5?2.7 at baseline to 22.4?3.5 (P=.04). There was tendency to reduce HbA1C in diabetics. No significant acceleration in gastric emptying was observed. 4 devices were removed due to pocket infection. Three patients died of causes not related to the GES. Conclusions: Long term GES significantly improves GI symptoms, especially nausea and vomiting, and the quality of life in patients with refractory gastroparesis. GES provides a novel, safe, and highly effective treatment for these challenging patients. |
