Impact of Combined Gastric and Sacral Stimulators on Upper/Lower Gastrointestinal and Urinary Symptoms

Abstract

Purpose: Gastric Electrical Stimulation (GES) is available as a Humanitarian Use Device for patients with the symptoms of gastroparesis and is effective in reducing gastrointestinal symptoms. We have previously shown that patients with gastric motor disorders often have co-existing abnormalities of the genitourinary system (Gastroenterol 112: A737, 1997), which may now be treated with sacral electrical stimulation (SES), resulting in similar improvements in genitourinary symptoms. SES has been shown to be beneficial in controlling fecal incontinence and resistant idiopathic constipation. Methods: We compared the results of therapy with GES and SES in 21 patients (19 F, 2 M, mean age of 39.7 years) who were implanted with both devices. Data for 16 patients is complete for upper and lower gastrointestinal and urinary symptoms. Patients had documented gastroparesis as well as bladder or other pelvic floor dysfunction. All 21 patients had received their GES before the SES. Patients were evaluated at baseline and latest follow up (median 4 years for GES and 2 years for SES). Scores of upper GI (GI: 0–4, TSS max 20), lower GI (GI: 0–3, TSS max9 and BM's per day), and GU (GU: 0–3, UTSS, max 18) function were recorded. Results were compared by paired t-tests & reported as mean ± SE. Results: All 16 patients improved both upper and lower GI and GU symptoms. Improvement in all parameters as nausea (2.81 vs. 71), vomiting (3.98 vs. 1.69), anorexia (3.4 vs. 1.48), bloating (3.7 vs. 12.07), abdominal pain (3.8 vs. 1.48) and gastric total symptom score (TSS) (17.14 vs. 7.43), leakage (1.48 vs. 29), urinary urgency (1.62 vs. 62), voiding difficulty (2.0 vs. 52), straining (1.44 vs. 44), trouble starting stream (1.5 vs. 38), number of pads used (.62 vs. .1) and urinary total symptom score (UTSS) (8.69 vs. 2.69), fecal urgency (.89 vs. .58), constipation (2.15 vs .74), fecal total symptom score (TSS) (3.63 vs. 1.63), and number of BM's per day (.97 vs. 1.7) were statistically significant. See table. Conclusion: The combination of GES and SES appears to be both safe and effective for patients with con-comitant gastroparesis and bladder dysfunction and SES improved coexistent fecal abnormalities as well.Table