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Treating an oft-unrecognized and troublesome entity: using gastric electrical stimulation to reduce symptoms of malignancy-associated gastroparesis

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Abstract

Purpose

Malignancy-associated gastroparesis (MAG) is a cause of morbidity in cancer patients but therapies are lacking. Gastric electrical stimulation (GES) is a novel treatment for MAG. Here, we describe 19 patients with MAG who underwent temporary GES placement.

Patients and methods

Nineteen patients (6 males, 13 females) with various malignancies were reviewed for symptom scores and physiologic measures at baseline and after temporary GES placement. Symptoms were scored by three variables: nausea (N), vomiting (V), and GI total symptom score (TSS). Physiologic profiles were measured by solid and liquid phase gastric emptying scans (GET) at 1, 2, and 4 h and cutaneous electrogastrogram (EGG) and mucosal electrogram (EG) frequencies. Symptoms were measured for 5 days after temporary endoscopic GES placement, and measures were repeated post GES placement.

Results

Baseline GET results displayed delayed gastric emptying in 16 of 19 patients (mean solid retention 21.7 % at 4 h, normal <10 %; mean liquid retention 10.4 % at 4 h, normal <5 %). Cutaneous EGG (mean frequency 5.5 cpm) and EG (mean proximal frequency 5.1 cpm; mean distal frequency 5.1 cpm) showed evidence of neuromuscular dysfunction (normal 2.5–3.3 cpm). Symptom scores in N, V, and TSS showed statistically significant reduction after GES placement.

Conclusion

A small sample of patients with MAG and receiving temporary GES experienced symptom improvement, with less change on gastric emptying time or gastric electrical amplitude or frequency. GES may provide a potential therapeutic option for symptomatic management of MAG and evaluation of these MAG patients after permanent GES placement is ongoing. Prospective studies of MAG using temporary and permanent GES may be warranted.

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Acknowledgments

The authors would like to thank the staff of the University of Mississippi Medical Center as well as the University of Louisville, especially the GI Motility Clinic at the Jewish Hospital/Kentucky One. They would also like to thank Catherine McBride for the help with manuscript preparation.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S Jackson Street, ACB3 A3L15, Louisville, KY, 40202, USA

    Hamza Shah, Gregg Wendorf, Shifat Ahmed, Lindsay McElmurray, Michael Hughes, Brian Beauerle, Ed Miller, Abigail Stocker & Thomas L. Abell

  2. University of Mississippi, Jackson, MS, USA

    Chris Lahr

Authors
  1. Hamza Shah
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  2. Gregg Wendorf
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  3. Shifat Ahmed
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  4. Lindsay McElmurray
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  5. Chris Lahr
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  6. Michael Hughes
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  7. Brian Beauerle
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  8. Ed Miller
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  9. Abigail Stocker
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  10. Thomas L. Abell
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Corresponding author

Correspondence to Thomas L. Abell.

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Conflict of interest

Dr. Abell has been a licensor, investigator, and consultant to Medtronic. Certain aspects of the technology of temporary gastric electrical stimulation are covered by intellectual property awarded to the University of Mississippi, now licensed to ADEPT-GI.

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Shah, H., Wendorf, G., Ahmed, S. et al. Treating an oft-unrecognized and troublesome entity: using gastric electrical stimulation to reduce symptoms of malignancy-associated gastroparesis. Support Care Cancer 25, 27–31 (2017). https://doi.org/10.1007/s00520-016-3375-z

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  • DOI: https://doi.org/10.1007/s00520-016-3375-z

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