457 Gastric Pacing Can Eliminate Dependency On Supplemental Nutrition and Improve Medically Refractory Gastroparesis

Abstract

INTRODUCTION: Gastric stimulation has been shown to improve the symptoms of medically refractory gastroparesis. With enough symptomatic improvement, patients should be able to decrease or eliminate their dependency on supplemental nutrition (parenteral or enteral) in the post-operative period. MATERIALS AND METHODS: This is a review of a single surgeons operative experience from 9/02 to 7/08. Patients with a diagnosis of diabetic or idiopathic gastroparesis that had a gastric pacer placed were selected for analysis. Chart review included age, gender, weight, symptom improvement, and the requirement of additional nutritional supplementation at baseline, six, and 12 months. RESULTS: Fifty-two patients had interrogation and programming of the gastric pacer (Enterra) at time of implantation. As part of follow-up, patients were assessed for symptom improvement and were adjusted appropriately if no improvement was seen. Patients included eight males and 44 females. The average age was 38 years (range 20-87). Thirty-one had a pre-operative, 6 month, and 12 month weight recording. Average weight was 151.9 lbs, 153.2 lbs, and 155.1 lbs at those respective times. In 47 patients with a mean follow-up of 19 months, 34 (72%) reported improvement in symptoms, nine (19%) reported no improvement in symptoms, and four had initial resolution of symptoms but return to baseline at last followup. Preoperatively, 10 patients were receiving jejunal feeds (TF) and two were receiving total parenteral nutrition (TPN). Subsequently after device implantation, seven patients at six months and an additional three at one year were off all forms of supplementation and receiving nutrition solely by mouth. No statistically significant weight change was seen in this group. Seven patients had a jejunostomy tube placed at the time of device implantation for subsequent enteral feeds. Three patients at six months had enteral feedings stopped and the remaining four continued tube feeds at one year. No patient in this group had an infectious complication secondary to concomitant gastric stimulator and jejunal tube placement. One Enterra system was replaced due to device malfunction, two revised secondary to generator malposition, and one removed due to lead erosion. CONCLUSIONS: The majority of patients demonstrated weight stability after gastric pacer placement. 72% of patients reported improvement in symptoms. Patients receiving supplemental nutrition preoperatively showed decreased reliance on enteral feeds or TPN after gastric stimulation. Concomitant jejunal tube and gastric pacer placement did not demonstrate a higher infectious complication rate.