HP21P HIGH‐FREQUENCY GASTRIC ELECTRICAL STIMULATION FOR THE TREATMENT OF GASTROPARESIS: A META‐ANALYSIS

Abstract

Purpose: High‐frequency gastric electrical stimulation (GES) is a relatively new treatment for medically‐refractory gastroparesis. There have been a number of clinical studies using a surgically‐implanted stimulator (Enterra, Medtronic, Minneapolis). A meta‐analysis was performed to evaluate the evidence for improved outcome.Methodology: A literature search of major medical databases was performed for the period January 1992 to August 2008. Studies involving an implanted high‐frequency GES device were included and reported a range of clinical outcomes. Studies of external, temporary and/or low frequency GES were excluded.Results: Of 13 included studies, 12 lacked controls and only one was blinded and randomized. Following GES, patients reported improvements in total symptom severity score (3/13 studies, mean difference 6.52 [CI: 1.32, 11.73], p = 0.01), vomiting severity score (4/13, 1.45 [CI: 0.99, 1.91], p < 0.0001), nausea severity score (4/13, 1.69 [CI: 1.26, 2.12], p < 0.0001), SF‐36 physical composite score (4/13, 8.05 [CI: 5.01, 11.10], p < 0.0001), SF‐36 mental composite score (4/13, 8.16 [CI: 4.85, 11.47], p < 0.0001), requirement for enteral or parenteral nutrition (8/13, OR 5.53 [CI: 2.75, 11.13], p < 0.001) and 4‐hour gastric emptying (5/13, 12.7% [CI: 9.8, 15.6], p < 0.0001). Weight gain did not reach significance (3/13, 3.68 kg [CI: –0.23, 7.58], p = 0.07). The device removal or reimplantation rate was 8.3%.Conclusion: Results show substantial benefits for high frequency GES in the treatment of gastroparesis. However, caution is necessary in interpreting the results, primarily due to the limitations of uncontrolled studies. Further controlled studies are required to confirm the benefits of high‐frequency GES.