Supplemental Enteral Feeding Research Articles

Initial experience and outcomes of per oral pyloromyotomy for the treatment of refractory gastroparesis.

Gastroparesis can be a debilitating disease process for which durable treatment options are lacking. While dietary changes and pharmacotherapy have some efficacy, symptoms frequently recur and some patients progress to needing supplemental enteral feeding access. Per oral pyloromyotomy (POP) has been shown to be a durable minimally invasive treatment option for refractory gastroparesis with a low side effect profile, and therefore has been performed at this institution for the past 6 years. This was a retrospective case series of all patients who underwent a POP at a single institution over a 6-year period (2018-2023). Patient demographics, preoperative symptomatology and subsequent workup, postoperative complications, and symptom recurrence were collected and analyzed. There were 56 patients included in the study. There was a 1.8:1 female:male ratio. The average patient age was 56 years old (range 23-85). The average duration of symptoms was 1-3 years. Thirty-eight percent of patients had undergone previous endoscopic therapy for gastroparesis (pyloric botox injection or pyloric dilation) and 16% of patients underwent multiple endoscopic therapies. Twenty-nine percent of patients were on a medication for gastroparesis. Past surgery was the most common gastroparesis etiology for POP (50% of patients). Diabetes (23%) and idiopathic (19%) were the other most common gastroparesis etiologies for POP. Nausea was the most common symptom at first follow-up (30%) but these patients continued to improve with 14% of patients continuing to endorse nausea at 6 months. Twenty-seven percent of patients developed symptom recurrence. Forty percent of patients with symptom recurrence underwent a repeat endoscopic or surgical therapy. In this present study, POP leads to durable results in approximately 75% of patients with minimal complications. Furthermore, the majority of patients who do develop symptom recurrence do not require additional gastroparesis interventions.

Gastrostomy Tube Feeding in Indian Children with Advanced Chronic Kidney Disease.

Guidelines recommend initiating supplemental enteral feeding through a nasogastric (NG) or gastrostomy tube (G-tube) in patients with chronic kidney disease who have inadequate oral intake despite repeated nutritional counseling. While G-tube placement is shown to improve both nutritional status and anthropometric indices of children with CKD in developed regions, information from developing countries is lacking. This retrospective report reviewed the impact of G-tube feeding on nutritional intakes and anthropometric parameters over a 1-y follow-up in 5 children with CKD-5D managed at one tertiary care center in India. Gastrostomy feeding facilitated significant increments in caloric and protein intake and was easy and safe. However, G-tube feeding led to additional expenses, and the changes in growth parameters were variable in the short term. A longer follow-up appears necessary to understand its impact on wasting, growth velocity, and stature.

Nutritional Care in Children with Cystic Fibrosis

Patients with cystic fibrosis (CF) are prone to malnutrition and growth failure, mostly due to malabsorption caused by the derangement in the chloride transport across epithelial surfaces. Thus, optimal nutritional care and support should be an integral part of the management of the disease, with the aim of ameliorating clinical outcomes and life expectancy. In this report, we analyzed the nutrition support across the different ages, in patients with CF, with a focus on the relationships with growth, nutritional status, disease outcomes and the use of the CF transmembrane conductance regulator (CFTR) modulators. The nutrition support goal in CF care should begin as early as possible after diagnosis and include the achievement of an optimal nutritional status to support the growth stages and puberty development in children, that will further support the maintenance of an optimal nutritional status in adult life. The cornerstone of nutrition in patients with CF is a high calorie, high-fat diet, in conjunction with a better control of malabsorption due to pancreatic enzyme replacement therapy, and attention to the adequate supplementation of fat-soluble vitamins. When the oral caloric intake is not enough for reaching the anthropometric nutritional goals, supplemental enteral feeding should be initiated to improve growth and the nutritional status. In the last decade, the therapeutic possibilities towards CF have grown in a consistent way. The positive effects of CFTR modulators on nutritional status mainly consist in the improvement in weight gain and BMI, both in children and adults, and in an amelioration in terms of the pulmonary function and reduction of exacerbations. Several challenges need to be overcome with the development of new drugs, to transform CF from a fatal disease to a treatable chronic disease with specialized multidisciplinary care.

Supplemental enteral tube feeding nutrition after hospital discharge of esophageal cancer patients who have undergone esophagectomy

BackgroundAfter undergoing esophagectomy to treat esophageal cancer, there are changes in the normal intake patterns in most patients, with more than half found to have an inadequate oral intake at the time of their hospital discharge. However, the use of home supplemental enteral tube feeding nutrition after hospital discharge in esophagectomy patients has yet to be established. The aim of this study was to evaluate the feasibility of 90-day home supplemental enteral tube feeding nutrition in esophagectomy patients.MethodsThis single-center, prospective, and single-arm study evaluated the feasibility of using supplemental tube feeding nutrition intervention for 90 days in esophageal cancer patients who have undergone esophagectomy.ResultsThis study enrolled 24 post-esophagectomy patients between February 2015 and September 2016. Twenty patients were administered 70% or more of the planned nutrient, with 83% of the patients completing the nutritional intervention procedure. There were no grade 3/4 adverse events observed, with a mean body weight change of − 7.6 ± 6.0%.ConclusionsOur results showed that routine use of 90-day home supplemental enteral tube feeding nutrition after hospital discharge for esophagectomy patients was both feasible and acceptable.Trial registrationUMIN000016286.

Surgical Gastrostomy in Pediatric Patients Undergoing Cardiac Surgery

BackgroundPractices of performing gastrostomy tubes vary across institutions for patients undergoing cardiac surgery. We aim to elucidate the outcomes of gastrostomy and the duration of feeding assistance in these patients. Materials and methodsPatients undergoing cardiac surgery (CS) at our institution from 2013 to 2017 were retrospectively reviewed using the Society of Thoracic Surgery database. A cohort of non-CS patients undergoing gastrostomy tube (g-tube) placement from 2013 to 2015 was used as control. Technical complications and postoperative feeding intolerance were analyzed. Duration of need for g-tube was also analyzed in patients undergoing CS. ResultsThe CS group had 144 patients, and the non-CS group had 677 patients. CS patients had a higher incidence of feeding intolerance (18.8% versus 5.6%, P < 0.001) and took longer to attain full feeds (median of 2 versus 1 d, P < 0.001), and this was confirmed on propensity matched analysis. In addition, technical g-tube complications were similar in the two groups. No mortality in CS was attributed to the g-tube. 58% of patients undergoing CS were able to wean from g-tube feeding by 6-12 mo after g-tube placement. ConclusionsG-tube placement in patients undergoing CS by any technique is safe without increased complications. A significant portion of these patients was able to wean off supplemental enteral feeding assistance by a year after g-tube placement.

Enteral tube feeding for cystic fibrosis.

Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The use of this method of feeding is assessed on an individual basis taking into consideration the patients age and clinical status. This is a final update of a previously published review. To examine the evidence that in people with cystic fibrosis, supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 10 July 2019.Date of the most recent hand search of PubMed: 26 October 2018. All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis. The searches identified 44 trials; however, none were eligible for inclusion in this review. There are no trials included in this review. Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are expensive and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement; but, efficacy has not been fully assessed by randomised controlled trials. It is acknowledged, however, that performing a randomised controlled trial would be difficult due to the ethics of withholding an intervention in a group of people whose nutritional status necessitates it.

Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed.

Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed.

Enteral tube feeding for cystic fibrosis.

Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The use of this method of feeding is assessed on an individual basis taking into consideration the patients age and clinical status. To examine the evidence that in people with cystic fibrosis, supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 13 February 2015.Date of the most recent hand search of PubMed and conference abstract books: 13 February 2015. All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis. The searches identified 38 trials; however, none were eligible for inclusion in this review. There are no trials included in this review. Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are expensive and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement; but, efficacy has not been fully assessed by randomised controlled trials. It is acknowledged, however, that performing a randomised controlled trial would be difficult due to the ethics of withholding an intervention in a group of patients whose nutritional status necessitates it.

Enteral Nutrition Support for Sarcopenia in End-Stage Liver Disease

Introduction: Weight loss with muscle wasting, also known as sarcopenia, commonly occurs in patients with end-stage liver disease (ESLD). A robust association between sacropenia and mortality in cirrhotic and post-liver transplant patients has been reported. This is a report of a patient with severe sacropenia and ESLD who was provided enteral nutrition using a Dobhoff tube (DHT) pre-liver transplant, resulting in successful bridging to transplant. Case Report: A 59-year-old male with chronic hepatitis C-related cirrhosis was awaiting liver/kidney transplant. Complications of his ESLD included hepatorenal syndrome, recurrent admissions for hepatic encephalopathy, variceal bleeding, and refractory ascites. In addition, the patient had continued to lose weight. The patient reported poor appetite and decreased oral intake. His body mass index (BMI) had fallen to 17.2 kg/m2 and raised concern by our transplant team about his ability to survive transplantation. Past surgical and family histories were unremarkable. Physical examination was notable for cachexia, temporal and thenar wasting, moderate abdominal distension, and lower extremity edema. Significant laboratory data included a pre-albumin of 6.0 mg/dL and albumin of 2.1 g/dL. Pre-transplant computed tomography of the abdomen and pelvis (CT a/p) of this patient revealed a mean total psoas area (TPA) of 820.70 mm2, indicating severe sarcopenia. A DHT was placed to improve his nutritional status and allow for home enteral feeding. The DHT was secured with a nasal bridle system (NBS) to prevent tube dislodgement. With enteral feeding, in addition to oral intake, the patient reported feeling less fatigued and lethargic. He gained 3 lbs, albumin rose to 3.0 g/dL, and he was not hospitalized until 1 month later, when he underwent successful simultaneous liver and renal transplant. Discussion: As previously reported, there is an increased incidence of perioperative morbidity and mortality associated with a low psoas muscle area, as measured on CT a/p at the level of the L4 vertebra. This case demonstrates that home enteral nutrition supplementation with a DHT is an option to be considered for improving a patient’s nutritional status pre-liver transplant. Although complications such as vomiting, diarrhea, and gastrointestinal bleeding are possible with this intervention, it is overall low-risk with regard to infection. DHT for supplemental enteral feeding should be considered in patients with pre-transplant sarcopenia to preserve their candidacy as a transplant candidate. Well-designed trials are needed to study this intervention to determine its overall effectiveness.

Guidelines for routine gastrostomy tube replacement in children

Endoscopic placement of a gastrostomy is the safest method of inserting a gastrostomy in children who are going to require full or supplemental enteral feeding for more than six weeks. Once a stoma tract has formed successfully following initial placement of a gastrostomy tube, the device can be changed to a balloon, button or non-balloon type. Community nursing teams often support a number of children with gastrostomies and their families, replacing the devices as necessary. Guidance for the safe insertion and replacement of balloon and button gastrostomies has been produced by the National Nurses Nutrition Group, the Patient Safety Agency and manufacturers, but standardised national guidelines are required.

265 The experience of adult patients with cystic fibrosis (CF) of percutaneous endoscopic gastrostomy (PEG) feeding

Objectives: Nutrition is crucial in cystic fibrosis. Supplemental enteral feeding either by naso-gastric tube feeds or more commonly gastrostomy feeds are advocated by CF centres to improve nutrition, respiratory function and quality of life in cystic fibrosis patients with significant faltering growth. A retrospective review of CFchildren in a tertiary centre to see the effect of gastrostomy feeds on anthropometry and lung function was undertaken. Methods and Results: Between 1990 and 2009 71 children had a gastrostomy inserted. Height, weight, BMI, FEV1, and FVC ‘Z’ scores 12 months, 6 months prior to and at insertion of gastrostomy were compared with the same measurements 6 and 12 months afterwards. Paired t-tests compared outcome variables at these time points. Median age of insertion was 10.5 yr (1.2, 19.2 yr). 37/71 (52%) were male. 48/71 (68%) were DF508 homozygous. Mean weight and BMI Z scores rose by 0.6 (p< 0.001) and 0.74 (p 0.01) retrospectively in the 12 months after gastrostomy insertion. FEV1 Z score fell by 0.90 (p 0.08) in the 12 months before insertion and reached no statistical significance (mean difference of 0.38, p 0.32) in 12 months after insertion. Conclusion: In CF children, weight and BMI improve after starting gastrostomy feeds but lung function although stabilised, does not improve.

Management of cystic fibrosis-related diabetes in children and adolescents

TheDepartment of Pediatrics, University of Minnesota Children’sHospital, Minneapolis, USACorresponding author:Dr. Stephen MP O’Riordan MRCPI, MDThe Developmental Endocrinology and Research GroupThe Department of Clinical and Molecular GeneticsThe Institute of Child Health, University College London30 Guliford StreetLondon WC1N 1EH.Tel: +44-020-7242-9789, ext. 0732;fax: +44-020-7404-6191;e-mail: s.oriordan@ich.ucl.ac.ukAcknowledgments:PeterHindmarsh,MehulDattani,HilaryHoeyand Nicola Bridges.Conflicts of interest: The authors have declared no conflictsof interest.Editors of the ISPAD Clinical Practice Consensus Guide-lines 2009 Compendium: Ragnar Hanas, Kim Donaghue,Georgeanna Klingensmith, and Peter Swift.This article is a chapter in the

Basics in Clinical Nutrition: Nutritional support in liver disease

In general, patients with liver disease tolerate a normal diet. The majority of patients do not need any dietary restrictions and they may even be harmed by them. A modified eating pattern with four to seven small meals including at least one late eveningmeal rich in carbohydrate improves nitrogen economy and substrate utilisation in stable cirrhotic patients. As a general rule, oral nutrition should be aimed for primarily and, only after failure to achieve the nutritional target for the individual patient despite intensive nutritional counselling, should supplemental enteral nutrition, tube feeding, or parenteral nutrition be employed.

Summary of ‘Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed’

AbstractThis is a summary of a Cochrane review, published in this issue of EBCH, first published as: Flint A, New K, Davies NW. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005092. DOI:10.1002/14651858.CD005092.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Commentary and Characteristics and Key Findings Tables. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Commentary on ‘Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Flint A, New K, Davies NW. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005092. DOI:10.1002/14651858.CD005092.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Characteristics and key findings for ‘Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed’

AbstractThese are the characteristics and key findings for a Cochrane review published in this issue of EBCH, first published as: Flint A, New K, Davies NW. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005092. DOI:10.1002/14651858.CD005092.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Commentary and Summary articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Cochrane review: Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed

AbstractBackgroundBreast milk provides optimal nutrition for newborn infants, and the ideal way for infants to receive breast milk is through suckling at the breast. Unfortunately, this may not always be possible, as there are numerous reasons why a newborn infant may not be able to breastfeed and, as a result, require supplemental feeding. Currently, there are a variety of ways in which newborn infants can receive supplemental feeds. Traditionally, bottles and nasogastric tubes have been used; however, more recently, cup feeding has become a popular practice in many nurseries in an attempt to improve breastfeeding rates. There is no consistency to guide the choice of supplementation.ObjectivesTo determine the effects of cup feeding versus other forms of supplemental enteral feeding on weight gain and achievement of successful breastfeeding in newborn infants who are unable to fully breastfeed.Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2006), CINAHL (1982 ‐ April 2006) and MEDLINE (1966 ‐ April 2006).Selection criteriaRandomised or quasi‐randomised controlled trials comparing cup feeding to other forms of enteral feeding for the supplementation of newborn infants.Data collection and analysisQuality assessments and data extraction for included trials were conducted independently by the review authors. Outcomes reported from these studies were: weight gain, proportion not breastfeeding at hospital discharge, proportion not feeding at three months of age, proportion not feeding at six months of age, proportion not fully feeding at hospital discharge, proportion not fully breastfeeding at three months of age, proportion not fully breastfeeding at six months of age, average time per feed (minutes), length of stay and physiological events of instability such as bradycardia, apnea, and low oxygen saturation. For continuous variables such as weight gain, mean differences and 95% confidence intervals were reported. For categorical outcomes such as mortality, the relative risks (RR) and 95% confidence intervals were reported.Main resultsFour studies were eligible for inclusion. The experimental intervention was cup feeding and the control intervention was bottle feeding in all four studies included in this review. There was no statistically significant difference in the incidence of not breastfeeding at hospital discharge in three included studies (typical RR 0.82, 95% CI 0.62, 1.09) and not breastfeeding at three months in two included studies (typical RR 0.88, 95% CI 0.76, 1.03) or six months for the one study that reported this outcome (RR 0.91, 95% CI 0.78, 1.05). There was a statistically significant difference in not fully breastfeeding at hospital discharge (from three included studies) in favour of cup feeding (typical RR 0.75, 95% CI 0.61, 0.92). However, this was not statistically significant at three months (one study, RR 1.18, 95% CI 0.88, 1.58) or six months (one study, RR 1.31, 95% CI 0.89, 1.92). There was no statistically significant difference in weight gain from one study that reported this outcome (MD ‐0.60, 95% CI ‐3.21, 2.01). In the one study that assessed it, there was a significantly increased length of hospital stay in the cup fed infants [mean difference between groups was 10.1 days (95% CI 3.9, 16.3)]. Time to full breastfeeding was not assessed in any study.Authors' conclusionsCup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no significant benefit in maintaining breastfeeding beyond hospital discharge and carries the unacceptable consequence of a longer stay in hospital.Plain language summaryIs cup feeding a better way to feed babies, rather than giving bottles or feeding with a tube, when mothers are unable to fully breastfeed?We wanted to identify the best way of offering feeds to babies when mothers are unable to breastfeed, or initially have difficulty with breastfeeding. Alternative feeding methods include using a cup, bottle or feeding tube. Four included studies compared cup and bottle feeding: the results of three of these studies demonstrate that infants who were cup fed were more likely to be exclusively breastfed at hospital discharge. However, at three and six months, there was no difference in the number of infants fully or partially breastfeeding, whether initially fed by cup, bottle or feeding tube. The results of one study demonstrated that those infants feed by cup spent approximately ten days longer in hospital. Therefore, based on available evidence, we cannot recommend cup feeding.

Reconstruction of the hypopharynx with the free jejunum transfer

Microsurgical techniques have revolutionized pharyngolaryngeal reconstruction. Free flap reconstruction with the free jejunal flap enables one stage reconstruction with minimal morbidity and mortality. This review will examine indications, operative technique, postoperative management, and expected outcomes for the hypopharyngeal reconstruction with the free jejunum flap. This procedure allows for maintenance of oral sections and rapid return of per-oral feeds and swallowing. The vast majority of patients resume swallowing and can maintain adequate nutrition without the need for supplemental enteral feeding via a tube. The free jejunal transfer can be rapidly harvested in most instances and transplanted to the hypopharyngeal region with a greater than 95% success rate. The jejunum fee flap is most useful for circumferential defects of the hypopharynx, but can also be used for partial defects. The most common local complications are stricture and fistula formation. A history of preoperative radiation therapy increases the risk of local complications.

Nutrition Support in the Morbidly Obese, Critically Ill Patient

Nutrition support in the critically ill patient is challenging but is even more difficult in a morbidly obese patient. This case report chronicles the care of a 6-foot-tall, 256-kg male (body mass index 76.5 kg/m(2)) who spent over a month in the intensive care unit for respiratory failure, sepsis, and acute renal failure. Parenteral nutrition was provided throughout his critical care course. One of the major difficulties encountered was determining his nutritional needs. A hypocaloric nutritional regimen was used, along with moderate protein provisions. Numerous electrolyte imbalances occurred, including hypercalcemia that did not resolve by eliminating calcium from the parenteral nutrition solution. Enteral nutrition was desired but was not used initially because of a need for vasopressors, a diagnosis of pancreatitis, difficulty in documenting feeding tube placement because of diagnostic limitations secondary to the patient's large size, and concern about managing stools. Eventually, oral intake and supplemental enteral feeding were initiated. Nutrition support team members worked closely with the interdisciplinary care team to develop strategies to manage the nutritional problems related to his obesity. A discussion of the various nutritional issues encountered in the care of this patient is provided. Reasonable nutritional status was achieved, but this case reflects some of the challenges encountered in caring for the nutritional needs of select patient populations in clinical practice and the need for increased research and guidelines in this area.

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA1c, and adverse events. In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery. In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.