Su1563 Evaluation and Treatment of Gastric Stimulator Failure

Abstract

Introduction: Some patients who undergo gastric electrical stimulation (GES) for gastroparesis (GP) develop recurrent symptoms i.e.: vomiting, nausea, early satiety, bloating, and abdominal pain despite an initial good result, replete with a functioning stimulator and unbroken leads. This study evaluates treatment for these patients, which includes temporary stimulation at a new gastric location and if symptoms are relieved this is followed by implantation of new leads and stimulator. We expect symptom scores to significantly decrease in the control group; we hypothesize that the symptom scores will also show a significant decrease in the replacement group. Patients: 15 patients with recurrent symptoms after placement of GES have undergone surgical insertions of a new gastric electrical stimulation (GES) system. Of the 15 replacement surgeries, 10 (67%) were female, 5 were male (33%) (mean age of all: 45), and 3 (20%) had diabetes-induced gastroparesis; the remainder (80%) were either idiopathic, post-surgical, or sarcoidosis-induced. Of 87 patients without recurrent symptoms after placement of GES who have not needed a replacement, 15 were selected as the control arm, matched by the three variables of investigator-derived independent outcome score (IDIOMS), baseline symptom scores before initial GES implantation, and etiology of disease (i.e. diabetic or idiopathic). Methods: Each patient met specific indications to receive GES replacement surgery. All patients had a preoperative diagnosis of either diabetic or idiopathic, drug-refractory, or post-surgical gastroparesis, and disordered gastric emptying with significant weight change. Patients with failed GES were evaluated over a 1-2 week period with insertion of a temporary endoscopic gastric stimulator. Patients with a positive response to temporary stimulation undergo GES replacement surgery. Common gastroparesis symptoms were evaluated before and after gastric pacemaker replacement using the Likert score system 0-4. These symptoms include vomiting, nausea, epigastric pain, early satiety and bloating. Results: See Tables 1 and 2. Total score of symptoms improved for 12 out of the 15 (80%) patients that underwent the GES replacement surgery. The frequency, amplitude, freq/ amplitude ratio (FAR), and gastric emptying times (GET) are displayed to reinforce physiological similarity between the two groups. Conclusion: Trial gastric mucosal electrical stimulation followed by implantation of new leads and stimulator successfully salvages the majority of patients whose gastric electrical stimulator is no longer relieving symptoms. Table 1 Comparison of Mean Pre-Op and Mean Post-Op Symptom Scores