2008 Annual Meeting Abstracts

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Background: Gastroparesis can be a difficult problem with patients suffering from symptoms intractable to medical management. Gastric neurostimulation has been developed as a treatment for diabetic and idiopathic gastroparesis for patients unresponsive to standard treatment. The purpose of this study is to report symptomatic and quality of life response to gastric neurostimulation.
Methods: This study was IRB-approved. Candidates for placement were patients with either idiopathic or diabetic gastroparesis who had symptomatic failure to standard dietary, prokinetic and antiemetic treatment. Prior to placement, the patients’ symptoms were recorded, and patients completed the Gastrointestinal Symptom Rating Scale (GSRS, three domains: dyspeptic syndrome, indigestion syndrome, and bowel dysfunction syndrome) and the SF-36 (eight domains: physical functioning, role-physical, role-emotional, bodily pain, vitality, mental health, social functioning, general health, plus a health transition item). The device (Enterra Therapy, Medtronic, Inc., Minneapolis, MN)was surgical placed using a hybrid laparoscopic/open technique. Patients were followed and adjustments made on the device until satisfactory symptom control was achieved or no response determined. At that time, patients completed both the GSRS and SF-36 and comparisons were made to preoperative values.
Results: 32 patients had the device placed, 23 females, mean age 42 + 14 yrs., with 20 diabetic patients and 12 idiopathic patients. 24 patients (75%) responded to variable degrees. 8 patients had no response. Of the responders, there were statistically significant improvements in all three domains of the GSRS--median scores (with interquartile ranges): Dyspeptic syndrome, 9 (7-12) to 4 (2-6), p=0.02; indigestion syndrome 5 (3-9) to 4 (0-4), p=0.02; bowel dysfunction syndrome 6 (3-8) to 3 (0-6), p=0.05. In the SF-36, there were statistically significant improvement in the health transition item, 4 (4-5) to 1.5 (1-3), p=0.01; and social functioning domain, 25 (12.5-62.5) to 75 (50-87.5), p=0.03. Of non-responders, there was no difference between preoperative and postoperative scores.
Conclusions: Three-quarters of gastroparesis patients respond to gastric neurostimulation to variable degrees. Gastrointestinal specific symptoms, health transition and social functiong are improved in responders. These results are encouraging considering that these patients had intractable symptoms with no other effective treatments available.

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