Table 8.

Effect of electro-acupuncture, acupuncture, and herbal medicines in gastroparesis

Electro-acupuncture
Device/trial design	Patients	Efficacy	Reference
Multicenter sham-controlled, XO, 4-week RCT of transcutaneous electroacupuncture (TEA) via surface ECG electrodes at acupoints PC6 and ST36.	26 DG patients, 18 completed study; TEA performed using pulse trains self-applied for 2 hrs. post-lunch/dinner	4-wk TEA, not sham-TEA, significantly improved 5 of 9 gastroparesis symptoms: nausea by 29.7%, vomiting by 39.3%, abdominal fullness by 21.4%, bloating by 20.6%, and retching by 31.1%. A significant change in pain was also noted with TEA.	Xu 2015, ref. 143
Acupuncture
Device/trial design	Patients	Efficacy	Reference
Single-blind, RCT, XO trial of acupuncture for 1 week vs sham acupuncture with 1-month washout period	25 DG patients	Real acupuncture was associated with significantly greater reductions in gastric retention at 2h and 4h and in GCSI score with no differences in fasting blood glucose or HbA1c	Li 2015, ref. 144
Single-center, DG comparison of acupuncture to control	Acupuncture treatment group (n=16 (5M/11F), 5 times per week 40 minutes each for 10 days, and a control group (n=16 (7M/9F).	Compared to control group, acupuncture resulted in the clinically significant improvement of the severity of symptoms and the GCSI nausea by 68,4%, retching by 76,8%, vomiting by 86,7%, stomach fullness by 62,5%, not able to finish a normal-sized meal by 21,2%, stomach visibly larger by 13,4%, loss of appetite by 12,8%, feeling excessively full after meals by 64,7% and bloating by 22.5%	Kostitska 2016, ref. 145
Single-center, RCT of acupuncture applied to Zusanii once per day and other acupoints compared to metoclopramide 20mg tid i.m.	Acute PSG in 63 patients	Significant differences in gastric drainage volume, cure rate and number of treatments with cure rate was 90.6% with acupuncture and 32.3% with metoclopramide	Sun 2010, ref. 146
Single-center comparison of 6-day Rx with acupoint stimulation (bilateral TEA) at Neiguan, PC-6 or prokinetic (metoclopramide, cisapride, erythromycin)	30 mechanically-ventilated neurosurgical ICU patients with delayed GE [gastric residual volume (GRV) >500 mL for ≥2 days]	After 5 days of treatment, 80% of patients in the acupoint group successfully developed feeding tolerance (GRV <200mL/24h) versus 60% in the prokinetic group; benefit was documented from day 1 of treatment. Similarly, feeding balance improved significantly on all days of treatment with acupoint vs. prokinetic therapy.	Pfab 2011, ref. 147
Single-center, open-label treatment with needleless TEA	11 patients with DG evaluated with visual stimulation (VS) to evoke nausea and EEG	TEA improves gastric dysrhythmia and ameliorates nausea. TEA treatment of nausea provoked by VS resulted in a change of dominance from right to left inferior frontal lobe activity on EEG.	Sarosiek 2017, ref. 148
RCT of acupuncture points: group A Zhongwan (CV 12) and Zusanli (ST 36); group B, Neiguan (PC 6) and Zusanli (ST 36); group C, non-acupoint and Zusanli (ST 36).	99 patients with gastroparesis at 3 clinical centers	Treatment was performed for 30 minutes every day, 5 days as a course of treatment. GCSI scores of each group after treatment and at follow-up were significantly lower than those before treatment (P <0.01), and the reduction in group A (Zhongwan (CV 12) and Zusanli (ST 36)) was greater than that of groups B and C (P <0.01). SF36 scores similar in the three groups.	Xuefen 2020, ref. 149
SRMA of acupuncture either manually stimulated (24 studies) or electrically stimulated (8 studies).	32 studies with a total of 2601 participants: DG (31 studies) or PSG (1 study)	There was low-certainty evidence that symptom scores of participants receiving acupuncture did not differ from those receiving sham acupuncture at 3 months when measured by a validated scale. There was very low-certainty evidence that acupuncture had ‘improved’ symptoms compared to gastrokinetic medication (4–12 weeks) (12 studies; 963 participants).	Kim 2018, ref. 150
SRMA of 14 RCTs of acupuncture	14 RCTs of DG	Acupuncture treatment had a higher response rate than controls (RR, 1.20 [95% confidence interval (CI), 1.12 to 1.29], P < 0.00001), and significantly improved dyspeptic symptoms compared with the control group.	Yang 2013, ref. 151
Open-label treatment with behavioral technique, autonomic training with directed imagery (verbal instructions)	26 patients with chronic nausea and vomiting	Gastrointestinal symptoms decreased by >30% in 58% of the treated patients; responders manifested mild to moderate delay in baseline GE; the sympathetic adrenergic measure (change in the foot cutaneous blood flow in response to cold stress) predicted improvement in autonomic training outcome.	Rashed 2002, ref. 152
Chinese Herbal Medicine
SRMA Banxiaxiexin decoction for DG	16 RCTs involving 1302 patients	Effect of Banxiaxiexin decoction (BXXD) for DG was superior to the control group (n = 1302, RR 1.23, 95% CI 1.17 to 1.29). Methodological quality of included studies was low, and long-term efficacy and safety are still uncertain.	Tian 2013, ref. 153
SRMA in comparison to conventional treatment (Western medicine treatment [metoclopramide, mosapride, cisapride, domperidone]), placebo, and no treatment (blank) for DG	Ten RCTs involving 867 patients (441 in the experimental groups [herbs alone], and 426 in the control groups [all prokinetic])	Effects of Xiangshaliujunzi Decoction (XSLJZD) for the treatment of DG were superior to the control group (n=867, RR=1.33, 95% CI: 1.24–1.42) based on symptoms and gastric emptying. Evidence remains weak due to the poor methodological quality of the included studies.	Tian 2014, ref. 154

DG=diabetic gastroparesis; GCSI=Gastroparesis Cardinal Symptom Index; GE=gastric emptying; PSG=post-surgical gastroparesis; RCT=randomized, controlled trial; SRMA=systematic review and meta-analysis; TEA= transcutaneous electroacupuncture; XO=crossover