Lee A Farber, DO, David B Earle, MD. Baystate Medical Center
Gastroparesis is a motility disorder of the stomach characterized by delayed passage of liquid and/or food boluses without a widely accepted effective treatment thus far. Our aim is to evaluate the effectiveness of an implantable gastric electrical stimulator device (Enterra®; Medtronic; Minneapolis, MN) in patients with diabetic or idiopathic gastroparesis as measured by patient estimate of the percentage improvement in their symptoms postoperatively.
Retrospective review of 23 patients with implantation of gastric stimulator between 2005 and 2011. Inclusion criteria were symptoms consistent with gastroparesis, abnormal nuclear medicine gastric emptying study and no evidence of an anatomic gastric outlet obstruction. All patients underwent laparoscopic implantation of the device with simultaneous upper endoscopy. Two leads were secured parallel to each other, 10cm proximal to the pylorus near the greater curvature of the stomach. All cases were successful, and had the stimulator turned on in the operating room. Patient responses concerning their percentage improvement over preoperative symptoms, demographics, and known complications were analyzed.
Two patients were lost to follow-up. Two patients had their stimulator removed due to infection or pain within six months, and one patient died of unrelated causes within one year. The remaining 18 (78%) patients were analyzed for symptom relief with a mean f/u of 22 months (0.5-71mos). Gender was male (n=7) and female (n=11), with a mean age of 47 years (22 to 69). Etiology was diabetes (61%) and idiopathic (39%). Preoperative symptoms were vomiting (n=17), nausea (n=16), hospital admission related to gastroparesis (n=12), abdominal pain (n=11), weight loss (n=11), and early satiety (n=3). All patients were refractory or intolerant to medical treatment. The mean overall symptom improvement was 62.2% (0-100%), with a median of 75%. 16 of 18 patients followed up beyond their initial postoperative visit (mean 25 months). Two patients were 0-10% improved, 4 were 50-70% improved, and 9 were 80-100% improved. Only 6 patients showed a decrease of 43% (5-90%) of initial symptom improvement during the subsequent follow up period.
Laparoscopic gastric stimulator implantation effectively relieves symptoms related to gastroparesis in patients with idiopathic or diabetic gastroparesis, and an abnormal gastric emptying study. While some complications occurred and results varied, but almost always met the goals and objectives of the patients, who had no other treatment alternative and would generally accept even a small improvement in symptoms. This modality should be considered in all medically refractory or medically intolerant patients with symptomatic gastroparesis.
Session Number: Poster – Poster Presentations
Program Number: P224