Skip to main content
SpringerLink
Log in

Laparoscopic Gastric Electrical Stimulation for Medically Refractory Diabetic and Idiopathic Gastroparesis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gastric electrical stimulator (GES) implantation is effective in certain patients with gastroparesis; however, laparotomy is often employed for placement. The aim of this study is to review outcomes of patients who underwent laparoscopic GES therapy for diabetic and idiopathic gastroparesis at a large referral center.

Methods

Patients who underwent GES (Enterra Therapy System; Medtronic, Minneapolis, MN) implantation with subsequent interrogation and programming between March 2001 and November 2011 were analyzed.

Results

A total of 113 patients underwent GES placement or revision during the study period. One hundred eleven patients underwent primary GES at our institution, while two patients underwent GES generator revision at our institution. Primary operations were completed laparoscopically in 110 of 111 cases, with one conversion to laparotomy due to severe adhesions. At a mean follow-up of 27 months (1–113), symptom improvement was achieved in 91 patients (80 %) and was similar for both the diabetic and idiopathic subgroups. Need for supplemental nutrition (enteral and/or parental) decreased in both groups.

Conclusions

GES 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. Need for supplemental nutrition is decreased following GES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Stanghellini V, Tosetti C, Paternico A, Barbara G, Morselli-Labate AM, Monetti N, Marengo M, Corinaldesi R. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology. 1996;110:1036–1042.

    Article  PubMed  CAS  Google Scholar 

  2. Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–2404.

    Article  PubMed  CAS  Google Scholar 

  3. Lee A, Kuo B. Metoclopramide in the treatment of diabetic gastroparesis. Expert Rev Endocrinol Metab. 2010;5:653–662.

    Article  PubMed  CAS  Google Scholar 

  4. Jung HK, Choung RS, Locke GR, 3rd, Schleck CD, Zinsmeister AR, Szarka LA, Mullan B, Talley NJ. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–1233.

    Article  PubMed  Google Scholar 

  5. McCallum R, Lin Z, Wetzel P, Sarosiek I, Forster J. Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol. 2005;3:49–54.

    Article  PubMed  Google Scholar 

  6. Kristensson K, Nordborg C, Olsson Y, Sourander P. Changes in the vagus nerve in diabetes mellitus. Acta Pathol Microbiol Scand A. 1971;79:684–685.

    PubMed  CAS  Google Scholar 

  7. Merio R, Festa A, Bergmann H, Eder T, Eibl N, Stacher-Janotta G, Weber U, Budka C, Heckenberg A, Bauer P, Francesconi M, Schernthaner G, Stacher G. Slow gastric emptying in type I diabetes: relation to autonomic and peripheral neuropathy, blood glucose, and glycemic control. Diabetes Care. 1997;20:419–423.

    Article  PubMed  CAS  Google Scholar 

  8. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–397.

    Article  PubMed  Google Scholar 

  9. Parkman HP, Camilleri M, Farrugia G, McCallum RW, Bharucha AE, Mayer EA, Tack JF, Spiller R, Horowitz M, Vinik AI, Galligan JJ, Pasricha PJ, Kuo B, Szarka LA, Marciani L, Jones K, Parrish CR, Sandroni P, Abell T, Ordog T, Hasler W, Koch KL, Sanders K, Norton NJ, Hamilton F. Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting. Neurogastroenterol Motil. 2010;22:113–133.

    Article  PubMed  CAS  Google Scholar 

  10. Hasler WL. Gastroparesis: symptoms, evaluation, and treatment. Gastroenterol Clin North Am. 2007;36:619–647, ix.

    Google Scholar 

  11. Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol. 2009;15:25–37.

    Article  PubMed  Google Scholar 

  12. Dhir R, Richter JE. Erythromycin in the short-and long-term control of dyspepsia symptoms in patients with gastroparesis. J Clin Gastroenterol. 2004;38:237–242.

    Article  PubMed  CAS  Google Scholar 

  13. Lata PF, Pigarelli DL. Chronic metoclopramide therapy for diabetic gastroparesis. Ann Pharmacother. 2003;37:122–126.

    Article  PubMed  CAS  Google Scholar 

  14. Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol. 2003;98:259–263.

    PubMed  CAS  Google Scholar 

  15. Dudekula A, O'Connell M, Bielefeldt K. Hospitalizations and testing in gastroparesis. J Gastroenterol Hepatol. 2011;26:1275–1282.

    Article  PubMed  Google Scholar 

  16. Coleski R, Anderson MA, Hasler WL. Factors associated with symptom response to pyloric injection of botulinum toxin in a large series of gastroparesis patients. Dig Dis Sci. 2009;54:2634–2642.

    Article  PubMed  Google Scholar 

  17. Chu H, Lin Z, Zhong L, McCallum RW, Hou X. A meta-analysis: The Treatment of High-Frequency Gastric Electrical Stimulation for Gastroparesis. J Gastroenterol Hepatol. 2011.

  18. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–1622.

    Article  PubMed  Google Scholar 

  19. McCallum RW, Lin Z, Forster J, Roeser K, Hou Q, Sarosiek I. Gastric electrical stimulation improves outcomes of patients with gastroparesis for up to 10 years. Clin Gastroenterol Hepatol. 2011;9:314–319 e311.

    Article  PubMed  Google Scholar 

  20. Grover M, Farrugia G, Lurken MS, Bernard CE, Faussone-Pellegrini MS, Smyrk TC, Parkman HP, Abell TL, Snape WJ, Hasler WL, Unalp-Arida A, Nguyen L, Koch KL, Calles J, Lee L, Tonascia J, Hamilton FA, Pasricha PJ. Cellular changes in diabetic and idiopathic gastroparesis. Gastroenterology. 2011;140:1575–1585 e1578.

    Article  PubMed  CAS  Google Scholar 

  21. Lin ZY, McCallum RW, Schirmer BD, Chen JD. Effects of pacing parameters on entrainment of gastric slow waves in patients with gastroparesis. Am J Physiol. 1998;274:G186–191.

    PubMed  CAS  Google Scholar 

  22. McCallum RW, Chen JD, Lin Z, Schirmer BD, Williams RD, Ross RA. Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology. 1998;114:456–461.

    Article  PubMed  CAS  Google Scholar 

  23. Al-Juburi A, Granger S, Barnes J, Voeller G, Beech D, Amiri H, Abell TL. Laparoscopy shortens length of stay in patients with gastric electrical stimulators. JSLS. 2005;9:305–310.

    PubMed  Google Scholar 

  24. Anaparthy R, Pehlivanov N, Grady J, Yimei H, Pasricha PJ. Gastroparesis and gastroparesis-like syndrome: response to therapy and its predictors. Dig Dis Sci. 2009;54:1003–1010.

    Article  PubMed  Google Scholar 

  25. Lin Z, Sarosiek I, Forster J, Damjanov I, Hou Q, McCallum RW. Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis. Neurogastroenterol Motil. 2010;22:56–61, e10.

    PubMed  CAS  Google Scholar 

  26. Pinto DA, Kaidar-Person O, Cho M, Roa P, Szomstein S, Rosenthal RJ. Laparoscopic placement of a gastric stimulator for the treatment of gastroparesis: a pilot study technique and results. Surg Laparosc Endosc Percutan Tech. 2008;18:144–150.

    Article  PubMed  Google Scholar 

  27. Hejazi RA, Sarosiek I, Roeser K, McCallum RW. Does grading the severity of gastroparesis based on scintigraphic gastric emptying predict the treatment outcome of patients with gastroparesis? Dig Dis Sci. 2011;56:1147–1153.

    Article  PubMed  Google Scholar 

  28. Musunuru S, Beverstein G, Gould J. Preoperative predictors of significant symptomatic response after 1 year of gastric electrical stimulation for gastroparesis. World J Surg. 2010;34:1853–1858.

    Article  PubMed  Google Scholar 

  29. Abell T, Lou J, Tabbaa M, Batista O, Malinowski S, Al-Juburi A. Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long-term follow-up. JPEN J Parenter Enteral Nutr. 2003;27:277–281.

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Kroh has served as a consultant and received honoraria for Intuitive, Bard, Ethicon, and Covidien. Dr. Bipan Chand has served as a consultant and received honoraria from Bard, Covidien, Ethicon, and Sanofi-Aventis. Drs. Timratana, El-Hayek, and Shimizu have no conflicts of interest or financial ties to disclose.

Financial Support

None

Author information

Authors and Affiliations

  1. Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, Ohio, 44195, USA

    P. Timratana, K. El-Hayek, H. Shimizu & M. Kroh

  2. Division of Gastrointestinal and Minimally Invasive Surgery, Loyola University Medical Center, Maywood, IL, 60153, USA

    B. Chand

  3. Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Bldg. 110-Room 3291, Maywood, IL, 60153, USA

    B. Chand

Authors
  1. P. Timratana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. El-Hayek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Kroh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Chand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Chand.

Additional information

Accepted for Poster Presentation at Digestive Diseases Week, 18–22 May 2012, San Diego, California. Abstract number: 1296366. Poster ID: Su1567.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Timratana, P., El-Hayek, K., Shimizu, H. et al. Laparoscopic Gastric Electrical Stimulation for Medically Refractory Diabetic and Idiopathic Gastroparesis. J Gastrointest Surg 17, 461–470 (2013). https://doi.org/10.1007/s11605-012-2128-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-2128-7

Keywords

Search

Navigation