Treating an oft-unrecognized and troublesome entity: using gastric electrical stimulation to reduce symptoms of malignancy-associated gastroparesis.

Abstract

Malignancy-associated gastroparesis (MAG) is a cause of morbidity in cancer patients but therapies are lacking. Gastric electrical stimulation (GES) is a novel treatment for MAG. Here, we describe 19 patients with MAG who underwent temporary GES placement. Nineteen patients (6 males, 13 females) with various malignancies were reviewed for symptom scores and physiologic measures at baseline and after temporary GES placement. Symptoms were scored by three variables: nausea (N), vomiting (V), and GI total symptom score (TSS). Physiologic profiles were measured by solid and liquid phase gastric emptying scans (GET) at 1, 2, and 4h and cutaneous electrogastrogram (EGG) and mucosal electrogram (EG) frequencies. Symptoms were measured for 5days after temporary endoscopic GES placement, and measures were repeated post GES placement. Baseline GET results displayed delayed gastric emptying in 16 of 19 patients (mean solid retention 21.7% at 4h, normal <10%; mean liquid retention 10.4% at 4h, normal <5%). Cutaneous EGG (mean frequency 5.5cpm) and EG (mean proximal frequency 5.1cpm; mean distal frequency 5.1cpm) showed evidence of neuromuscular dysfunction (normal 2.5-3.3cpm). Symptom scores in N, V, and TSS showed statistically significant reduction after GES placement. A small sample of patients with MAG and receiving temporary GES experienced symptom improvement, with less change on gastric emptying time or gastric electrical amplitude or frequency. GES may provide a potential therapeutic option for symptomatic management of MAG and evaluation of these MAG patients after permanent GES placement is ongoing. Prospective studies of MAG using temporary and permanent GES may be warranted.