Gastric electrical stimulation (GES) is an accepted form of therapy for gastroparesis and is considered for compassionate therapy in patients with refractory nausea and vomiting. The U. S. Food and Drug Administration has approved GES for treatment of drug-refractory idiopathic gastroparesis and diabetic gastroparesis, but it has also been used off label for related conditions.
Although GES has been shown to improve the frequency of nausea and vomiting in patients with idiopathic and diabetic gastroparesis, it has also shown benefit in patients affected by the symptoms of gastroparesis, ie, nausea, vomiting, and abdominal pain, but with nondelayed gastric emptying, referred to as gastroparesis-like syndrome or unexplained nausea and vomiting. Because not all patients with gastroparesis and gastroparesis-like syndrome benefit from GES, a trial of temporary gastric stimulation (Fig. 1) can help determine those who would benefit from placement of a permanent gastric stimulator, which requires surgery.
Figure 1.
A, Endoscopic view of placement of temporary gastric stimulator leads. B, Retained esophageal food. C, Retained gastric food.
The techniques for endoscopic and surgical placement of gastric electrical stimulators are not widely known or performed. The purpose of this video (Video 1, available online at www.VideoGIE.org). is to highlight the important aspects of temporary gastric electrical stimulator lead placement with advanced endoscopic techniques, which may then lead to the surgical placement of a permanent gastric stimulator.
Disclosure
Dr Abell is a reviewer for UpToDate, the recipient of grants from Theravance and Vanda, a stockholder in ADEPT-GI, and an editor with MedStudy, Neuromodulation, and Wikistim. All other authors disclosed no financial relationships relevant to this publication.
Footnotes
Written transcript of the video audio is available online at www.VideoGIE.org.
Supplementary data
In this video we show the endoscopic technique of temporary gastric stimulator lead placement in patients with diabetic gastroparesis and gastroparesis-like syndrome. These patients can be very difficult to manage with medical therapies; however, some respond very well to gastric stimulation with significant improvement in symptoms.
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Supplementary Materials
In this video we show the endoscopic technique of temporary gastric stimulator lead placement in patients with diabetic gastroparesis and gastroparesis-like syndrome. These patients can be very difficult to manage with medical therapies; however, some respond very well to gastric stimulation with significant improvement in symptoms.