Digestive Diseases and Sciences

, Volume 53, Issue 8, pp 2072–2078 | Cite as

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

  • Jennifer L. Maranki
  • Vanessa Lytes
  • John E. Meilahn
  • Sean Harbison
  • Frank K. Friedenberg
  • Robert S. Fisher
  • Henry P. ParkmanEmail author
Original Paper


The objectives of this study were to determine the clinical response to Enterra gastric electric stimulation (GES) in patients with refractory gastroparesis and to determine factors associated with a favorable response. Methods This study was conducted in patients undergoing Enterra GES for refractory gastroparesis. Symptoms were scored before and after GES implantation using the Gastroparesis Cardinal Symptom Index (GCSI) with additional questions about abdominal pain and global clinical response. Results During an 18-month period, 29 patients underwent GES implantation. Follow-up data were available for 28 patients, with average follow-up of 148 days. At follow-up, 14 of 28 patients felt improved, 8 remained the same, and 6 worsened. The overall GCSI significantly decreased with improvement in the nausea/vomiting subscore and the post-prandial subscore, but no improvement in the bloating subscore or abdominal pain. The decrease in GCSI was greater for diabetic patients than idiopathic patients. Patients with main symptom of nausea/vomiting had a greater improvement than patients with the main symptom of abdominal pain. Patients taking narcotic analgesics at the time of implant had a poorer response compared to patients who were not. Conclusions GES resulted in clinical improvement in 50% of patients with refractory gastroparesis. Three clinical parameters were associated with a favorable clinical response: (1) diabetic rather than idiopathic gastroparesis, (2) nausea/vomiting rather than abdominal pain as the primary symptom, and (3) independence from narcotic analgesics prior to stimulator implantation. Knowledge of these three factors may allow improved patient selection for GES.


Gastroparesis Enterra gastric electric stimulation Diabetic gastroparesis 



This study was supported in part by a NIH Midcareer Investigator Award in Patient-Oriented Research to HP Parkman (NIH DK02921).


  1. 1.
    McCallum RW, Chen JDZ, Lin Z, Schirmer BD, Williams RD, Ross RA (1988) Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 114:456–461CrossRefGoogle Scholar
  2. 2.
    Abell T, Custem EV, Abrahamsson H, Huizinga JD, Konturek JW, Galmiche JP, Voeller G et al (2002) Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 66:204–221PubMedCrossRefGoogle Scholar
  3. 3.
    Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, Lindberg G, Konturek J, Nowak T, Quigley EM, Tougas G, Starkebaum W (2003) Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 125:421–428PubMedCrossRefGoogle Scholar
  4. 4.
    Cutts TF, Luo J, Starkebaum W, Rashid H, Abell TL (2005) Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term healthcare benefits? Neurogastroenterol Motil 17:35–43PubMedCrossRefGoogle Scholar
  5. 5.
    Lin Z, McElhinney C, Sarosiek I, Forster J, McCallum R (2005) Chronic gastric electrical stimulation for gastroparesis reduces the use of prokinetic and/or antiemetic medications and the need for hospitalizations. Dig Dis Sci 50(7):1328–1334PubMedCrossRefGoogle Scholar
  6. 6.
    Jones MP, Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98(10):2122–2129PubMedCrossRefGoogle Scholar
  7. 7.
    Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2004) Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res 13(4):833–844PubMedCrossRefGoogle Scholar
  8. 8.
    Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2003) Development and validation of a patient-assessed gastroparesis symptoms severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther 18:141–150PubMedCrossRefGoogle Scholar
  9. 9.
    Guo J-P, Maurer AH, Urbain J-L, Fisher RS, Parkman HP (2001) Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 46:24–29PubMedCrossRefGoogle Scholar
  10. 10.
    Lin Z, McElhinney C, Sarosiek I, Forster J, McCallum R (2005) Chronic gastric electrical stimulation for gastroparesis reduced the use of prokinetic and/or antiemetic medications and the need for hospitalizations. Dig Dis Sci 50:1328–1334PubMedCrossRefGoogle Scholar
  11. 11.
    Abell T, Lou J, Tabaa M, Batista O, Malinowski S, Al-Juburi A (2003) Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long-term follow up. J Parenter Enteral Nutr 98:277–281CrossRefGoogle Scholar
  12. 12.
    Lin Z, Forster J, Sarosiek I, McCallum RW (2004) Treatment of gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 27(5):1071–1076PubMedCrossRefGoogle Scholar
  13. 13.
    Lin Z, Sarosiek I, Forster J, McCallum RW (2006) Characteristics of outcomes of gastric electrical stimulation in diabetic, postsurgical and idiopathic gastroparesis. Gastroenterology 130:A135 (abstract)Google Scholar
  14. 14.
    Abell T, Al-Juburi A, Rashed H, Mirocha A (2005) 13 years, 214 patients and over 5000 patient months: a long term report on gastric electric stimulation. Gastroenterology 128(4 Suppl 2):A282 (abstract)Google Scholar
  15. 15.
    Parkman HP, Gonlachanvit S, Hsu C-W, Kantor S, Knight LC, Boden GH, Maurer AH, Fisher RS (2003) Effect of altering gastric emptying on postprandial glucose following a physiologic meal in type II diabetic patients. Dig Dis Sci 48:488–497PubMedCrossRefGoogle Scholar
  16. 16.
    AMS Gastroparesis Task Force, Abell TL, Bernstein RK, Cutts T, Farrugia G, Forster J, Hasler WL, McCallum RW, Olden KW, Parkman HP, Parrish CR, Pasricha PJ, Prather CM, Soffer EE, Twillman R, Vinik AI (2006) Treatment of gastroparesis: a multidisciplinary review. Neurogastroenterol Motil 18(4):263–283Google Scholar
  17. 17.
    Forster J, Damjanov I, Lin Z, Sarosiek I, Wetzel P, McCallum RW (2005) Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 9:102–108PubMedCrossRefGoogle Scholar
  18. 18.
    Ayinala S, Batista O, Goyal A, Al-Juburi A, Abidi N, Familoni B, Abell T (2005) Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 61:455–461PubMedCrossRefGoogle Scholar
  19. 19.
    Oubre B, Luo J, Al-Juburi A, Voeller G, Familoni B, Abell TL (2005) Pilot study on gastric electric stimulation on surgery-associated gastroparesis: long-term outcome. South Med J 98:693–697PubMedCrossRefGoogle Scholar
  20. 20.
    McCallum R, Lin Z, Wetzel P, Sarosiek I, Forster J (2005) Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol 3(1):49–54PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jennifer L. Maranki
    • 1
  • Vanessa Lytes
    • 1
  • John E. Meilahn
    • 2
  • Sean Harbison
    • 2
  • Frank K. Friedenberg
    • 1
  • Robert S. Fisher
    • 1
  • Henry P. Parkman
    • 1
    Email author
  1. 1.Department of Medicine, Gastroenterology SectionTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of SurgeryTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations