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Dadlani A, Naing LY, Woldesellassie F, Mathur P, Stocker A, Daniels M, Abell TL. The role of gastric electrical stimulation in postsurgical gastroparesis: a retrospective analysis from 2 centers. J Gastrointest Surg 2024:S1091-255X(24)00572-9. [PMID: 39128559 DOI: 10.1016/j.gassur.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Postsurgical gastroparesis, resulting from surgical interventions on the stomach or vagal nerve injury, poses significant clinical challenges with patients presenting symptoms such as nausea, vomiting, and abdominal pain. Although gastric electrical stimulation (GES) offers potential relief, its efficacy in refractory postsurgical gastroparesis requires further examination. This study evaluated the clinical response to GES in patients with refractory postsurgical gastroparesis. METHODS A retrospective study was conducted across 2 study sites, involving 185 patients with drug-refractory postsurgical gastroparesis who underwent both temporary and permanent GES placements. Patients were categorized based on their surgical history: bariatric surgery, Nissen fundoplication, and others. The impact of GES was evaluated using Food and Drug Administration-compliant patient-reported outcomes scores and other relevant clinical metrics at baseline, after temporary GES placement, and 6 months after permanent GES placement. All 3 groups were also analyzed by the symptom improved group vs the unimproved group at baseline and 6 months after GES placement. RESULTS After GES implantation, all patient groups significantly improved upper gastrointestinal symptoms. The bariatric surgery group and Nissen fundoplication group specifically identified anorexia as the most severe symptom after GES after temporary GES placement among 3 groups (2.5 [0.4-3.5] and 1.5 [0.0-2.5], respectively). Nissen fundoplication patients had the highest score of anorexia among the 3 groups 6 months after GES (3.0 [2.0-3.5], P = .018). Despite these improvements, GES did not enhance gastric emptying test results. Symptomatic improvements were notably significant in patients who initially reported higher symptom severity than those who did not. CONCLUSION GES shows promise in alleviating symptoms of refractory postsurgical gastroparesis, particularly in those with severe initial symptoms. However, its impact on gastric emptying remains inconclusive. Further research is needed to establish GES as a standard treatment for postsurgical gastroparesis.
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Affiliation(s)
- Apaar Dadlani
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Le Yu Naing
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Fitsum Woldesellassie
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Prateek Mathur
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Abigail Stocker
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Michael Daniels
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States
| | - Thomas L Abell
- Division of Gastroenterology, Department of Medicine, The Arthur M. Schoen MD Chair in Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, United States.
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Gastric Electrical Stimulators Causing Erosion Through the Colonic Wall. ACG Case Rep J 2020; 7:e00313. [PMID: 32440521 PMCID: PMC7209803 DOI: 10.14309/crj.0000000000000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022] Open
Abstract
Gastroparesis is a chronic motor disorder of the stomach characterized by the demonstration of delayed gastric emptying without obstruction and a grouping of symptoms including nausea, vomiting, early satiety, postprandial fullness, bloating and abdominal pain. When conservative medical management is not effective, gastric electrical stimulation is an effective alternative. Gastric electrical stimulation, in general, has had a low complication rate as of yet, with the most common being infection of the implanted device. We present a complication in which the gastric electrical stimulator electrodes eroded through the colonic wall.
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