Abstract
Background
Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution.
Methods
A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement.
Results
A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea.
Conclusions
Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obese patients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.
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References
Jones, M. P., Maganti, K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003;98(10):2122–2129.
Abell, T., McCallum, R., Hocking, M., Koch, K., Abrahamsson, H., Leblanc, I., Lindberg, G., Konturek, J., Nowak, T., Quigley, E. M. et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003;125(2):421–428.
Abell, T. L., Van Cutsem, E., Abrahamsson, H., Huizinga, J. D., Konturek, J. W., Galmiche, J. P., VoelIer, G., Filez, L., Everts, B., Waterfall, W. E. et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002;66(4):204–212.
McCallum, R. W., Chen, J. D., Lin, Z., Schirmer, B. D., Williams, R. D., Ross, R. A. Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology. 1998;114(3):456–461.
Cutts, T. F., Luo, J., Starkebaum, W., Rashed, H., Abell, T. L. Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits? Neurogastroenterol Motil. 2005;17(1):35–43.
Lin, Z., McElhinney, C., Sarosiek, I., Forster, J., McCallum, R. Chronic gastric electrical stimulation for gastroparesis reduces the use of prokinetic and/or antiemetic medications and the need for hospitalizations. Dig Dis Sci. 2005;50(7):1328–1334.
Bortolotti, M. The "electrical way" to cure gastroparesis. Am J Gastroenterol. 2002;97(8):1874–1883.
Lin, Z., Forster, J., Sarosiek, I., McCallum, R. W. Treatment of gastroparesis with electrical stimulation. Dig Dis Sci. 2003;48(5):837–848.
McCallum, R. W., Snape, W., Brody, F., Wo, J., Parkman, H. P., Nowak, T. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol. 2010;8(11):947–54; quiz e116.
Abell, T. L., Minocha, A. Gastroparesis and the gastric pacemaker: a revolutionary treatment for an old disease. J Miss State Med Assoc. 2002;43(12):369–375.
Buckles, D. C., Forster, J., McCallum, R. W. The treatment of gastroparesis in the age of the gastric pacemaker: a review. MedGenMed. 2003;5(4):5.
O'Grady, G., Egbuji, J. U., Du, P., Cheng, L. K., Pullan, A. J., Windsor, J. A. High-frequency gastric electrical stimulation for the treatment of gastroparesis: a meta-analysis. World J Surg. 2009;33(8):1693–1701.
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(4):277–281.
Kastenmeier AS, Makris KI, Dunst CM, Swanstrom LL, Gastric Electrical Stimulation: Surgical Complications and Impact on Supplemental Nutrition (Poster), DDW Annual Meeting, Chicago, IL, 5/2011.
Maranki, J. L., Lytes, V., Meilahn, J. E., Harbison, S., Friedenberg, F. K., Fisher, R. S., Parkman, H. P. Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis. Dig Dis Sci. 2008;53(8):2072–2078.
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Keller, D.S., Parkman, H.P., Boucek, D.O. et al. Surgical Outcomes After Gastric Electric Stimulator Placement for Refractory Gastroparesis. J Gastrointest Surg 17, 620–626 (2013). https://doi.org/10.1007/s11605-013-2147-z
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DOI: https://doi.org/10.1007/s11605-013-2147-z