Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries.

Abstract

Gastric electrical stimulation (GES) for treating gastroparesis symptoms is controversial. We studied 319 idiopathic or diabetic gastroparesis symptom patients from the Gastroparesis Clinical Research Consortium (GpCRC) observational studies: 238 without GES and 81 with GES. We assessed the effects of GES using change in GCSI total score and nausea/vomiting subscales between baseline and 48weeks. We used propensity score methods to control for imbalances in patient characteristics between comparison groups. GES patients were clinically worse (40% severe vs. 18% for non-GES; P<.001); worse PAGI-QOL (2.2. vs. 2.6; P=.003); and worse GCSI total scores (3.5 vs. 2.8; P<.001). We observed improvements in 48-week GCSI total scores for GES vs. non-GES: improvement by≥1-point (RR=1.63; 95% CI=(1.14, 2.33); P=.01) and change from enrollment (difference=-0.5 (-0.8, -0.3); P<.001). When adjusting for patient characteristics, symptom scores were smaller and not statistically significant: improvement by≥1-point (RR=1.29 (0.88, 1.90); P=.20) and change from the enrollment (difference=-0.3 (-0.6, 0.0); P=.07). Of the individual items, the nausea improved by≥1 point (RR=1.31 (1.03, 1.67); P=.04). Patients with GCSI score ≥ 3.0 tended to improve more than those with score < 3.0. (Adjusted P = 0.02). This multicenter study of gastroparesis patients found significant improvements in gastroparesis symptoms among GES patients. Accounting for imbalances in patient characteristics, only nausea remained significant. Patients with greater symptoms at baseline improved more after GES. A much larger sample of patients is needed to fully evaluate symptomatic responses and to identify patients likely to respond to GES.