43 Gastric Electrical Stimulation in Severe Gastroparesis – The Scottish Experience

Introduction:  Gastroparesis (GP) is a common complication of type 1 and 2 diabetes affecting up to 50% of the diabetic population. In severe cases diabetic gastroparesis (DGP) may be profoundly disabling with severe GI symptoms, prolonged hospital stay and potentially life-threatening metabolic upset. Standard management of DGP with dietary changes or drug treatment is unsatisfactory in many patients. The development of gastric electrical stimulation (GES) in drug refractory DGP has been shown to be beneficial in this difficult group of patients. In Scotland GES has only recently been available as a treatment option and we report here our initial experience in both diabetic and idiopathic gastroparesis patients. We have treated 7 patients (5 female), age 30 (21–73) (median, range) over a 3 years period. Of the 7 patients 5 were type 1 diabetics and 2 had idiopathic gastroparesis. All had severe drug refractory GP and 6/7 had required enteral feeding prior to GES implantation. All 7 patients had GES initiated with the Enterra (Medtronic) neural stimulator placed at mini-laparotomy. No peri-operative complications were noted. One patient died of unrelated sepsis 6 month post-implant. GES was initiated with standard parameters (frequency 14 Hz, intensity 5 mA, pulse width 330 μs; cycle on 0.1 s; cycle off 5 s). All 6 patients who had required enteral feeding pre-GES had their feeding tubes removed at surgery and have had normal nutritional intake without supplemental feeding after GES [follow-up 24 month (11–34)].Gastric emptying as assessed by dual phase solid/liquid labeled meals improved in 50% of our patients. Conclusions:  GES significantly improves the weekly vomiting frequency in patients with GP and avoids the need for enteral feeding. Long-term GES should be considered as a treatment option in all drug refractory GP patients. Results (6 months) PRE POST GES   Median (range)   Weekly vomiting frequency 25 (15–35) 4 (1–6) *p < 0.001 Weight (kg) 49 (44–70) 54 (50–89) p = ns