Matthew J Davis, MD1, Andrew T Strong, MD1, Ivy N Haskins1, Kevin M El-Hayek, MD1, Michael S Cline, DO2, Matthew D Kroh, MD1, John Rodriguez, MD1. 1Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, 2Department of Gastroenterology, Cleveland Clinic
Introduction: Gastroparesis is a chronic and debilitating disease, with an increasing prevalence in the United States. Prokinetic, antiemetic medications and behavioral modification are mainstays for therapy, but the failure rate remains high. For patients refractory to medical therapy, Gastric Electrical Stimulator (GES) may be considered. There are various indications for device removal. Outcomes of patients who have previously undergone GES therapy have not been studied after explantation.
Methods: An IRB approved, prospectively maintained database of 209 patients who have received GES at our institution was queried for patients who underwent explantation. Demographic data, pre- and post-operative symptomatology, as well as perioperative data were collected. All patients who eventually underwent explantation were included in this study.
Results: Twenty-two patients met inclusion criteria, which represents 11% of our total implants. Nineteen patients were female (86%). Nine patients had gastroparesis secondary to diabetes, while the remaining were classified as idiopathic. Age at implantation ranged from 21 – 74 years. Mean pre-stimulator BMI was 26 kg/m2 (range 16 – 40). The most common pre-implantation symptoms were nausea (86%, n=19), vomiting (82%, n=18), inability to finish a meal (68%, n=15) and chronic abdominal pain (64%, n=14). Routine follow up after stimulator insertion to a mean of 12 months (range, 1 – 73) showed improvement or resolution of nausea in 59% of patients (n=13), vomiting in 55% (n=12), and abdominal pain in 27% (n=6).
Average time to explantation was 44 months (range 1 – 149). Indications for stimulator explant included: failure of symptomatic relief (50%, n=11), generator and/or lead infection (18%, n=4), lead erosion (14%, n=3), generator pain and/or discomfort (14%, n=3), and patient complaint of shocking sensation (5%, n=1). Two of the patients in the failure of relief group had their devices removed as part of a small bowel transplant. Three patients underwent conversion to Roux-en-Y gastrojejunostomy (RYGJ) and three had new enteral access placed at the time of device removal.
Post-operative data was available for eighteen patients. Twelve patients (67%) suffered from nausea, seven (39%) reported continued emesis, four (22%) were unable to finish a meal, and eight (44%) reported chronic abdominal pain. Notably, two of the patients who reported no further symptoms were from those who were converted to RYGJ.
Conclusion: GES has shown efficacy in the treatment of gastroparesis. Indications for explantation are variable, but may occur in over 10% of patients. Some patients may maintain symptomatic improvement even following explant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80333
Program Number: P380
Presentation Session: Poster (Non CME)
Presentation Type: Poster