2725 Electrode Perforation Into Stomach Complicating Gastric Electrical Stimulation

Abstract

INTRODUCTION: Gastric electrical stimulation is not FDA-approved, but available on a compassionate basis in the management of refractory gastroparesis. We describe a patient with refractory gastroparesis treated by gastric electrical stimulation who developed the rare complication of electrode migration into the lumen of the stomach. CASE DESCRIPTION/METHODS: A 31 year old female with idiopathic gastroparesis was refractory to maximal medical therapy including polypharmacy and feeding jejunostomy. Her gastric emptying was delayed with only 78% gastric emptying after 4 hours on gastric emptying scan (normal > 90%). A gastric electrical stimulator was placed 4 years prior to presentation, on a compassionate use basis. A battery change was required 2 years later. Settings were gradually increased to maximal, at 5 mA, pulse width of 360 us, rate 40 Hz, cycle on 2 seconds, cycle off 3 seconds. Two years later she complained of stabbing epigastric pain, and a recurrence of her gastroparesis symptoms, with nausea, vomiting, coffee ground emesis, and early satiety. On physical exam she was afebrile and non-toxic, with mild epigastric tenderness. CT showed a non-specific 3.7 cm fluid density adjacent to the stomach around the gastric pacemaker lead. Upper endoscopy revealed that two of the leads had penetrated into the gastric lumen. Gastric retention of food was also noted, even though the patient had been nothing by mouth for 12 hours prior to the procedure. Surgery confirmed that 2 of the gastric pacemaker leads had eroded into the stomach. The leads were removed, and new leads placed more proximally in the stomach. A surgical pyloroplasty was also performed. The patient did well in the 18 months of post-operative follow-up. DISCUSSION: Lead perforation into the stomach following gastric electrical stimulation is rare. As far as we are aware, there are 3 previously reported cases. In addition, there is one report of electrode perforation into the small bowel. We speculate that higher energy settings, and longer duration of cycles on may be a risk factor for this complication. Sudden epigastric pain, recurrence of gastroparesis symptoms, and a fluid collection at the electrode insertion site, may be clues as to the development of this rare complication.