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Background: Gastroparesis is a disorder of chronic nausea and vomiting that may result in failure to thrive. Etiologies are multifactorial, but most often are classified as diabetic, idiopathic, post-surgical, or medication induced. Several large series have shown efficacy of gastric pacer implantation in certain groups with gastric dysfunction. However, laparotomy is often employed for placement. The aim of this study is to review outcomes of all patients who underwent gastric pacer therapy regardless of etiology.

Methods: Patients who underwent gastric pacer (Enterra Therapy System; Medtronic, Minneapolis, MN) implantation with subsequent interrogation and programming between March 2001 and November 2011 were analyzed. Data reviewed included demographics, pre-operative symptoms, operative technique, and post-operative symptom and nutritional improvement.

Results: A total of 113 patients underwent gastric pacer placement during the study period. Mean age was 40 years (19-88) and 83% of patients were female. Operations were completed laparoscopically in 110/111 cases, with one conversion to laparotomy due to severe adhesions. Two cases involved pacer revision for battery replacement. Gastroparesis symptoms were present for a mean duration of 4.8 years prior to surgery (1-20). Surgical intervention was only offered for patients with medical refractory diabetic and idiopathic gastroparesis. Prior to implantation, thirty-three patients were on supplemental nutrition (23 on jejunal feeds and 10 on total parental nutrition). There were no operative or immediate peri-operative complications. Battery depletion occurred in 6 patients at a mean interval of 75 months. Pacer malfunction occurred in 4 cases. Two of these cases required removal secondary to lead erosion, 1 underwent conversion to Roux-en Y gastric bypass, and 1 had no therapy. At a mean follow-up of 24 months, symptom improvement was achieved in 91 patients (80%) and was similar for both the diabetic and idiopathic subgroups. Post-operatively, 15 of 23 patients were able to discontinue supplemental nutrition. BMI increased in both the idiopathic and diabetic cohorts (see Graph 1 and 2). Four patients underwent conversion to laparoscopic Roux-en-Y gastric bypass for persistent poorly controlled symptoms and morbid obesity with associated comorbidities. Symptom control was achieved in 2 of these patients with an overall mean excess weight loss of 22% (8-39) at 7 month follow-up (3-12).

Conclusion: Gastric pacer placement is feasible using a laparoscopic approach. Medical refractory gastroparesis in the diabetic and idiopathic groups had significant symptom improvement with no difference between the two groups. Gastric pacing may decrease the need for ongoing supplemental nutrition.