Gastric Electrical Stimulation

There are factors critical to the success of Gastric Electrical Stimulation. One of the most important is careful patient selection.

Who can benefit from Gastric Electrical Stimulation?

GES is indicated for use in the treatment of chronic, intractable (drug refractory) nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology.

Patients suspected to have gastroparesis should be evaluated for the Enterra® Gastric Neurostimulation System based on the following:

  • Documented gastroparesis of diabetic or idiopathic origin based on nuclear medicine emptying study
  • Chronic nausea and vomiting
  • Refractory or intolerant to prokinetics/antiemetics
  • Must be viable surgical candidate
  • Symptoms must be of physiological origin
  • Patients are recommended to undergo detoxification from narcotics prior to implant

Evaluating Patients

Many symptoms of gastroparesis mimic those of other disorders or are the result of side effects from certain medications, making it difficult to reach a definitive diagnosis.

Patients suspected to have gastroparesis should be evaluated for GES based on the following:

  1. Documented gastroparesis of diabetic or idiopathic origin based on nuclear medicine emptying study
  2. Chronic nausea and vomiting
  3. Refractory or intolerant to prokinetics/antiemetics
  4. Must be viable surgical candidate
  5. Symptoms must be of physiological origin
  6. Patients are recommended to undergo detoxification from narcotics prior to implant

Symptoms & Treatment

Chronic nausea and frequent vomiting are the most debilitating symptoms of gastroparesis, differentiated from other disorders by key warning signs, such as:

  • Nausea and vomiting occurring several times a day and episodes occurring for longer than 12 months
  • Repeated hospitalizations and supplemental nutrition needed due to nausea and vomiting
  • Inadequate relief of symptoms from medications for nausea and vomiting
  • Diminished quality of life due to chronic nausea and vomiting
  • Weight loss or excessive weight gain over the past year due to improper nutrition resulting from chronic nausea and vomiting

In addition to nausea and vomiting, symptoms of gastroparesis may include:1

  • Abdominal bloating and pain
  • Early satiety after only a few bites of food
  • Heartburn or GERD
  • Changes in blood sugar levels
  • Lack of appetite

Treatment Options

There is no cure for gastroparesis but there are treatment options that can control the symptoms of chronic vomiting and nausea. Often, multiple therapies are used in combination.2

An overview of care for gastroparesis includes:

  • Diet Modifications
  • Antiemetic drugs
  • Prokinetic drugs
  • Psychological support
  • Pain Control
  • Enterra Therapy (Gastric Electrical Stimulation)
  • Enteral nutrition (Total parenteral nutrition -- TPN)
  • Gastrectomy

References

  1. Abell T, McCallum R, Hocking M, et al.Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 2003; 125(2):421-28.
  2. Abell T, McCallum R, Bernstein RK, Cutts T, et al. Treatment of gastroparesis: a multidiscliplinary clincial review. Neurogastroenteral Motil. 2006; 18(4): 263-283.

Patient Selection Tools

This is used for initial screening of Gastroparesis and gastric stimulation using the Enterra® Gastric Neurostimulation System. Patients may complete the questionnaire on their own or get assistance from a healthcare professional.

Give the diary to patients to help them monitor symptoms, medications, and other pertinent events while they are being evaluated for symptoms of gastroparesis.

Humanitarian Device: The effectiveness of this device for this use has not been demonstrated.