Gastric Electrical Stimulation

Overview

Approximately 4% of the population suffers from gastroparesis or delayed emptying of the stomach. The symptoms include refractory nausea and vomiting. Many patients have Type I or Type II diabetes but some patients have idiopathic gastroparesis. These two groups of patients, idiopathic and diabetic, comprise about 66% of patients with gastroparesis. The other large group of patients has gastroparesis or delayed gastric emptying secondary to gastrectomies or previous surgery on the stomach. Once the diagnosis is made with a Gastric Emptying study, many patients may be eligible for Gastric Electrical Stimulation or Enterra Therapy. Stimulation has been available since the mid-1990's and is manufactured by Medtronic, Inc. (Minneapolis, MN).

Procedure

The device (Fig. 1) consists of two electrodes implanted into the wall of the stomach. The leads are then attached to a generator that is placed beneath the skin in the subcutaneous fat. All components are placed within the abdominal wall or stomach. Once the device is implanted laparoscopically through 4 small incisions (Fig 2), the device is turned ON.

Gastroparesis procedure figures

Advantages of the Procedure

To date this is one of the only surgical procedures that provides reliable and durable relief of nausea and vomiting for patients with refractory symptoms. The laparoscopic technique avoids a large incision and enhances recovery for patients in terms of pain and a faster return to normal activities.

Recovery

Most patients are discharged on post-operative day #1. Each patient is then followed in clinic as an outpatient. The parameters of the generator can be changed using radiofrequency technology in the out patient clinic. Overall, the device decreases the severity and frequency of symptoms; mainly nausea and vomiting. Currently, the Department of Surgery has one of the widest experiences in the nation with Gastric Electrical Stimulation for Gastroparesis.

Publications

Brody F, Vaziri K, Saddler A, Ali A, Drenon E, Hanna B, Akin E, Gonzalez F, Soffer E. Gastric electrical stimulation for gastroparesis. J Am Coll Surg. 2008 Oct;207(4):533-8.

Brody F, Nam A, Drenon E, Ali A, Soffer E. Laparoscopic insertion of gastric electrodes for electrical stimulation. J Laparoendosc Adv Surg Tech A. 2007 Feb;17(1):1-6.

Aviv R, Policker S, Brody F, Bitton O, Haddad W, Kliger A, Sanmiguel CP, Soffer EE. Circadian patterns of gastric electrical and mechanical activity in dogs. Neurogastroenterol Motil. 2008 Jan;20(1):63-8.

Sanmiguel CP, Aviv R, Policker S, Haddad W, Brody F, Soffer EE. Association between gastric electromechanical activity and satiation in dogs. Obesity (Silver Spring). 2007 Dec;15(12):2958-63.

Xing J, Felsher J, Brody F, Soffer E. Gastric electrical stimulation significantly increases canine lower esophageal sphincter pressure. Dig Dis Sci. 2005 Aug;50(8):1481-7.

Brody F, Chand B, Brodsky J, Soffer E. Laparoscopic revision of gastric pacing wires. J Laparoendosc Adv Surg Tech A. 2004 Jun;14(3):187-9.

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