Preoperative Predictors of Significant Symptomatic Response After 1 Year of Gastric Electrical Stimulation for Gastroparesis

• Published in: World journal of surgery 2010-08, Vol.34 (8), p.1853-1858
• Main Authors: Musunuru, Sandeepa, Beverstein, Gretchen, Gould, Jon
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Biological and medical sciences; Cardiac Surgery; Diabetes Complications - diagnostic imaging; Diabetes Complications - therapy; Electric Stimulation Therapy - adverse effects; Female; Gastric Electrical Stimulation; Gastroenterology. Liver. Pancreas. Abdomen; Gastroparesis; Gastroparesis - diagnostic imaging; Gastroparesis - etiology; Gastroparesis - therapy; General aspects; General Surgery; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Mental Component Summary; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Other diseases. Semiology; Physical Component Summary; Predictive Value of Tests; Quality of Life; Radionuclide Imaging; Retrospective Studies; Statistics, Nonparametric; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Thoracic Surgery; Total Symptom Score; Treatment Outcome; Vascular Surgery; Vomiting - etiology
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0586-1

Background In cases of gastroparesis where significant symptoms fail to respond to standard medical therapy, gastric electrical stimulation (GES) may be of benefit. Unfortunately, not all patients improve with this therapy. Reliable preoperative predictors of symptomatic response to GES may allow clinicians to offer this expensive and invasive treatment to only those patients most likely to benefit. Methods Therapy was initiated in 15 patients more than 12 months prior to this retrospective review of our prospectively maintained data. All patients completed a Total Symptom Score (TSS) survey at every encounter as well as the SF-36 quality-of-life instrument prior to surgery. A failure of GES therapy was considered to have occurred when after 1 year of treatment, preoperative TSS had not decreased by at least 20%. Results Four patients (4 idiopathic) failed to improve more than 20% on multiple assessments after a year of therapy. All diabetic patients experienced a durable symptomatic improvement with GES. Review of individual items of the TSS revealed that nonresponders experienced less severe vomiting preoperatively. Conclusions Diabetic gastroparesis patients respond best to GES. Responders tend to have more severe vomiting preoperatively. Patients with idiopathic gastroparesis who do not experience severe vomiting should be cautioned about a potentially higher rate of poor response to GES and may be better served with alternative treatments.