Surgical Outcomes After Insertion of Gastric Neurostimulator for Refractory Gastroparesis-a Single Institution’s Experience

Ihab Saab, MD, Kellie McFarlin, MD. Henry Ford Hospital.

 INTRODUCTION:

Gastric electric stimulation (GES) has been approved by the FDA under a humanitarian device exemption for treatment of patients with refractory symptoms of diabetic gastroparesis (DG) or idiopathic gastroparesis (IG). Our goal is to evaluate the effect of GES on body mass index (BMI) and the hemoglobin A1C (HbA1c) of patients who underwent insertion of a gastric neurostimulator at a single institution.

METHODS AND PROCEDURES:

A retrospective review of patients who underwent laparoscopic insertion of gastric neurostimulator for refractory IG or DG from June 2004 to June 2013 was analyzed. We compared the rates of symptomatic response to therapy, the overall treatment period, different patient demographic parameters, body mass index (BMI) and the hemoglobin A1c (HbA1c) levels at implant time, 6, 12 and 60 months intervals. ANOVA was used to analyze the data.

RESULTS:

A total of 137 patients had a GES implanted with a median age of 43.9 years (range: 19.5-78 years); 105 of which are still active patients in our database. Twenty-five percent (n=34) where females. Sixty-four percent (n=87) had the GES inserted for DG and thirty-six percent (n=50) for IG. 

  0 months 6 months 12 months 24 months 60 months
HbA1c 7.95 7.2 8.07 7.78 6.98
SD 1.86 0.91 1.87 2.05 1.29
BMI 26.68 28.66 27.5 31 34.9
SD 6.72 6.59 7.02 5.67 8.58

* Mean HbA1c and mean BMI reported.
* SD: Standard Deviation

The HbA1c trended down when followed from 0 to 60 months (p= 0.738) The BMI increased (p=0.049).

CONCLUSION:

GES has been shown to improve quality of life and symptom scores in previous studies. Our study shows improved weight stabilization while on GES therapy and stabile HbA1c over a long duration of therapy. Further studies are needed to delineate the cause and effect of this outcome and if device settings play a role.

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