Jean Luo

Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits?

Abstract  Context:  Severe upper gastrointestinal (GI) motor disorders, including gastroparesis (GP), can consume significant health care resources. Many patients are refractory to traditional drug therapy.

Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: Long-term outcome

Objectives: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis. Methods: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time. Results: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying. Conclusions: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.

Gastric electrical stimulation is associated with improvement in pancreatic exocrine function in humans.

Objective: To define the possible effects of gastric electrical stimulation (GES) for gastroparesis on pancreatic function, we performed 2 related human studies. Methods: Fecal elastase values were compared in 2 patient groups: (1) GES devices ON and (2) GES devices OFF and (2) in 3 control groups: (1) no response (NR) to prokinetic medications, (2) positive response (RES) to medications, and (3) normal controls. Polypeptide levels in 7 of 9 GES patients with device ON and OFF, elastase results, GI symptoms (TSS), and heart rate variability (HRV) were compared by paired t tests and/or ANOVA and reported as mean ± SE. Results: Elastase was different for GES-ON and OFF (508.0 ± 92.2 vs. GES-OFF 378.6 ± 87.4, P < 0.05). Elastase was lower in medication NR and RES than in normal controls. Postprandial pancreatic polypeptide was greater with GES ON than OFF (P = 0.07). HRV revealed a lower percentage of change with device ON versus OFF (44.2 ± 5.5 vs. 48.5 ± 5.2, P = 0.08) and lower TSS with ON versus OFF (15.9 ± 4.5 vs. 25.7 ± 5.3, P < 0.05). Conclusions: GES improves exocrine pancreatic release, effects autonomic control, and improves GI symptoms, suggesting a possible role for GES in the treatment of pancreatic insufficiency associated with gastroparesis.

Long term treatment at gastric electrical stimulation is associated with changes in neuro enteric function

Long term treatment at gastric electrical stimulation is associated with changes in neuro enteric function

Gastric electrical stimulation is associated with increased pancreatic exocrine secretion measured by pancreatic elastase

Hereditary pancreatitis (HP)is an autosomal dominant disorder with incomplete penetrance. It is characterized by recurrent episodes of severe abdominal pain which often presents in early childhood. A mutation in the cationic trypsinogen gene has been identified in this disease. Medical management of HP at times may be different. In non-hereditary pancreatitis, the approach to management is tailored towards the individual etiology, (sphincter of Oddi dysfunction, common bile duct stones, ect.) Aim: To determine if ERCP therapeutic intervention has any role in resolving the frequency of pain in HP. Methods: We have evaluated, retrospectively using a computer data base retrieval system, a series of nine pts who had documented, by history, familial pancreatitis. All of the pts reported pain or recurrent abdominal pain on initial presentation. They reported multiple hospitalizations prior to the initial presentation per acute pancreatitis. Five of 9 pts had pancreatic duct (PD) stone. Four out of 9 pts had a PD stricture. Two of 9 had both PD stricture and stones. Two of 9 pts had no stones or strictures, but did have blunting of the terminal branches of the PD, consistent with chronic pancreatitis. Results: ERCP outlined the PD in all pts, Only those pts with PD stones or PD stricture had improvement with either endoscopic sphincterotomy, PD stent placement or stone retrieval. Two of 9 pts had no PD stones or strictures and did not have any symptomatic improvement with ERCP intervention as noted by no significant change in frequency of abdominal pain or hospitalizations. Conclusion: Preliminary results have shown that a therapeutic ERCP is only helpful when there are structural defects such as pancreatic duct strictures or pancreatic duct stones. In the absence of such structural defects therapeutic intervention may have little benefit. 5295