Doris Kim, MD, Shelby Allen, MD, Ryan Gedney, BS, Haley Zlombke, MD, Elizabeth Winter, BS, John Craver, BS, William Lancaster, MD, David Adams, MD. Medical University of South Carolina
INTRODUCTION: Gastric electrical stimulation (GES) in the management of gastroparesis has had mixed clinical response, which may in part be due to the variety in underlying etiology. The most common etiologies of gastroparesis intractable to medical management are diabetes, surgical vagal nerve injury following foregut operations, and idiopathic. The aim of this study was to identify which patient populations are more likely to benefit from GES.
METHODS AND PROCEDURES: A retrospective review and analysis was undertaken on patients who underwent GES for gastroparesis management over a ten-year period. Patient demographics, medical and surgical history, need for enteral or parenteral nutrition postoperatively, weight gain or loss, and readmission rates were evaluated.
Each patient was stratified into an etiological subset (diabetes, idiopathic, or post-surgical) and compared using outcome measure categories identified above. For each measure, subsets were compared to each other using a Chi-Squared Test. A Two-Tailed T-Test was also performed to compare average weight gain or loss of each subset of patients. A significance value of p < 0.05 was used.
RESULTS: 185 patients underwent GES from 2005-2015. 81.1% were woman (n=150) with an average age of 44 years old (range 17-84 years). 49.7% were diabetic, 37.3% idiopathic, and 13% post-surgical. 8.7% of patients had a concurrent diagnosis of colonic inertia. 20.5% of gastric neurostimulators were later explanted (3.2% due to infection, 5.9% for pain, 10.3% for continued symptoms, 1.1% for symptom resolution). 26.5% underwent generator exchanges for continued therapy with an average of 2.2 exchanges (range 1-10). 26.5% of patients required enteral nutrition and 8.7% required parenteral nutrition after neurostimulator placement. 11.4% of patients were readmitted within 30 days of neurostimulator placement, with 85.7% for PO intolerance and 1.1% due to infection.
Patients with prior foregut surgery had the highest incidence of weight gain (56%), followed by diabetic (50%) and idiopathic (38%) 3-6 months post placement (p=0.016). Idiopathic patients experienced significant weight loss compared to diabetic and post-surgical patients (48%, 40%, 34%, respectively, p = 0.017). Diabetic patients demonstrated the highest incidence of continued therapy compared to post-surgical and idiopathic patient populations(87% vs 69% vs 70%, respectively, p = 0.0001).
CONCLUSIONS: Patients with gastroparesis had different clinical outcomes after GES therapy based on their underlying etiology. Post-surgical gastroparetics demonstrated the highest likelihood of weight gain after implantation. Diabetic gastroparetics were most likely to continue pacemaker therapy. Idiopathic gastroparetics were more likely to have weight loss.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95486
Program Number: S018
Presentation Session: Foregut I
Presentation Type: Podium