BACKGROUND: Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution. METHODS: A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement. RESULTS: A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea. CONCLUSIONS: Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obese patients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.
BACKGROUND: Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution. METHODS: A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement. RESULTS: A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea. CONCLUSIONS: Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obesepatients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.
Authors: Richard W McCallum; William Snape; Fredrick Brody; John Wo; Henry P Parkman; Thomas Nowak Journal: Clin Gastroenterol Hepatol Date: 2010-06-09 Impact factor: 11.382
Authors: Thomas L Abell; Eric Van Cutsem; Hasse Abrahamsson; Jan D Huizinga; J W Konturek; Jean Paul Galmiche; Guy VoelIer; Ludo Filez; Bernt Everts; William E Waterfall; W Domschke; Stanislas Bruley des Varannes; Babajide O Familoni; Ivan M Bourgeois; Jozef Janssens; Gervais Tougas Journal: Digestion Date: 2002 Impact factor: 3.216
Authors: Thomas Abell; Richard McCallum; Michael Hocking; Kenneth Koch; Hasse Abrahamsson; Isabelle Leblanc; Greger Lindberg; Jan Konturek; Thomas Nowak; Eammon M M Quigley; Gervais Tougas; Warren Starkebaum Journal: Gastroenterology Date: 2003-08 Impact factor: 22.682
Authors: Gregory O'Grady; John U Egbuji; Peng Du; Leo K Cheng; Andrew J Pullan; John A Windsor Journal: World J Surg Date: 2009-08 Impact factor: 3.352
Authors: Jennifer L Maranki; Vanessa Lytes; John E Meilahn; Sean Harbison; Frank K Friedenberg; Robert S Fisher; Henry P Parkman Journal: Dig Dis Sci Date: 2007-12-14 Impact factor: 3.199