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World Journal of Surgery

, Volume 34, Issue 8, pp 1853–1858 | Cite as

Preoperative Predictors of Significant Symptomatic Response After 1 Year of Gastric Electrical Stimulation for Gastroparesis

  • Sandeepa Musunuru
  • Gretchen Beverstein
  • Jon Gould
Article

Abstract

Background

In cases of gastroparesis where significant symptoms fail to respond to standard medical therapy, gastric electrical stimulation (GES) may be of benefit. Unfortunately, not all patients improve with this therapy. Reliable preoperative predictors of symptomatic response to GES may allow clinicians to offer this expensive and invasive treatment to only those patients most likely to benefit.

Methods

Therapy was initiated in 15 patients more than 12 months prior to this retrospective review of our prospectively maintained data. All patients completed a Total Symptom Score (TSS) survey at every encounter as well as the SF-36 quality-of-life instrument prior to surgery. A failure of GES therapy was considered to have occurred when after 1 year of treatment, preoperative TSS had not decreased by at least 20%.

Results

Four patients (4 idiopathic) failed to improve more than 20% on multiple assessments after a year of therapy. All diabetic patients experienced a durable symptomatic improvement with GES. Review of individual items of the TSS revealed that nonresponders experienced less severe vomiting preoperatively.

Conclusions

Diabetic gastroparesis patients respond best to GES. Responders tend to have more severe vomiting preoperatively. Patients with idiopathic gastroparesis who do not experience severe vomiting should be cautioned about a potentially higher rate of poor response to GES and may be better served with alternative treatments.

Keywords

Physical Component Summary Mental Component Summary Gastroparesis Total Symptom Score Gastric Electrical Stimulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Hasler WL (2008) Gastroparesis—current concepts and considerations. Medscape J Med 10(1):16PubMedGoogle Scholar
  2. 2.
    Abell T, McCallum R, Hocking M et al (2003) Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 125:421–428CrossRefPubMedGoogle Scholar
  3. 3.
    Monnikes H, van der Voort I (2006) Gastric electrical stimulation in gastroparesis: where do we stand? Dig Dis 24:260–266CrossRefPubMedGoogle Scholar
  4. 4.
    Waseem S, Moshiree B, Draganov PV (2009) Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol 15:25–37CrossRefPubMedGoogle Scholar
  5. 5.
    Brody F, Vaziri K, Saddler A et al (2008) Gastric electrical stimulation for gastroparesis. J Am Coll Surg 207:533–538CrossRefPubMedGoogle Scholar
  6. 6.
    McKenna D, Beverstein G, Reichelderfer M et al (2008) Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis. Surgery 144:566–572CrossRefPubMedGoogle Scholar
  7. 7.
    Gould JC, Dholakia C (2009) Robotic implantation of gastric electrical stimulation electrodes for gastroparesis. Surg Endosc 23:508–512CrossRefPubMedGoogle Scholar
  8. 8.
    Revicki DA, Rentz AM, Dubois D et al (2003) Development and validation of a patient assessed gastroparesis symptom severity measure: the gastroparesis cardinal symptom index. Aliment Pharmacol Ther 18:141–150CrossRefPubMedGoogle Scholar
  9. 9.
    Lin Z, Sarosiek I, Forster J et al (2006) Symptom responses, long-term outcomes and adverse events beyond 3 years of high-frequency gastric electrical stimulation for gastroparesis. Neurogastroenterol Motil 18:18–27CrossRefPubMedGoogle Scholar
  10. 10.
    Ayinala S, Batista O, Goyal A et al (2005) Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 61(3):455–461CrossRefPubMedGoogle Scholar
  11. 11.
    Lin Z, Forster J, Sarosiek I et al (2004) Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 27(5):1071–1076CrossRefPubMedGoogle Scholar
  12. 12.
    Maranki JL, Lytes V, Meilahn JE et al (2008) Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis. Dig Dis Sci 53:2072–2078CrossRefPubMedGoogle Scholar
  13. 13.
    Abidi N, Starkebaum WL, Abell TL (2006) An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation. Neurogastroenterol Motil 18:334–338CrossRefPubMedGoogle Scholar
  14. 14.
    Velanovich V (2008) Quality of life and symptomatic response to gastric neurostimulation for gastroparesis. J Gastrointest Surg 12(10):1656–1662CrossRefPubMedGoogle Scholar
  15. 15.
    Soykan I, Sivri B, Sarosiek I et al (1998) Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 43(11):2398–2404CrossRefPubMedGoogle Scholar
  16. 16.
    Lin Z, Hou Q, Sarosiek I et al (2008) Association between changes in symptoms and gastric emptying in gastroparetic patients treated with gastric electrical stimulation. Neurogastroenterol Motil 20:464–470CrossRefPubMedGoogle Scholar
  17. 17.
    McCallum RW, Dusing RW, Sarosiek I et al (2006) Mechanisms of high-frequency electrical stimulation of the stomach in gastroparetic patients. Conf Proc IEEE Eng Med Biol Soc 1:5400–5403CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Sandeepa Musunuru
    • 1
  • Gretchen Beverstein
    • 1
  • Jon Gould
    • 1
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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