Aim: To test temporary percutaneous gastric electrical stimulation (TPGES) in patients with drug-refractory nausea/vomiting and nonestablished indications for GES. Methods: 27 patients (2–81 years) underwent TPGES with electrodes implanted at gastroscopy and received stimulation for 7–21 days with low current settings (5–7 mA) either as open stimulation (n = 14) or randomized to double-blind crossover stimulation (n = 13; ON for 12–14 days, OFF for 12–14 days). Symptoms were recorded daily. Nonresponders were offered another period (14–21 days) with increased stimulation (8–10 mA). Results: Mean lead implantation time was 14 min. Leads were kept implanted for ≤60 days. 22 of 27 evaluable patients had a favorable symptom reduction, preferentially of nausea/vomiting, irrespective of delayed or normal gastric emptying rate: postsurgical gastroparesis 7/8, chronic intestinal pseudo-obstruction 2/2, idiopathic gastroparesis 1/1, functional dyspepsia 6/9, diabetes mellitus 2/2, postsurgical nausea/vomiting 2/2, malformation syndrome 1/1, intestinal neuropathy 1/1, intestinal interstitial cells of Cajal deficiency 0/1. 6 patients had a clear symptom reduction during the ON period compared with stimulation OFF. Four of 7 patients improved with increased stimulation (8–10 mA). Twenty of the 22 responders received a permanent GES implant, 90% of them still being responders at last follow-up. Conclusion: TPGES seems promising to study new indications for GES and to select responders/non-responders.

Journal Section:
Original Paper
Keywords:
Electrodes, Gastric electrical stimulation, Gastroparesis, Vomiting, Nausea
1.
Abell TL, Van Cutsem E, Abrahamsson H, Huizinga JD, Konturek JW, Galmiche JP, VoelIer G, Filez L, Everts B, Waterfall WE, Domschke W, Bruley des Varannes S, Familoni BO, Bourgeois IM, Janssens J, Tougas G: Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 2002;66:204–212.
[PubMed]
https://doi.org/10.1159%2F000068359
2.
Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, Lindberg G, Konturek J, Nowak T, Quigley EM, Tougas G, Starkebaum W: Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 2003;125:421–428.
[PubMed]
https://doi.org/10.1016%2FS0016-5085%2803%2900878-3
3.
Lin Z, Forster J, Sarosiek I, McCallum RW: Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 2004;27:1071–1076.
[PubMed]
https://doi.org/10.2337%2Fdiacare.27.5.1071
4.
Lin Z, McElhinney C, Sarosiek I, Forster J, McCallum R: Chronic gastric electrical stimulation for gastroparesis reduces the use of prokinetic and/or antiemetic medications and the need for hospitalizations. Dig Dis Sci 2005;50:1328–1334.
[PubMed]
https://doi.org/10.1007%2Fs10620-005-2782-7
5.
McCallum R, Lin Z, Wetzel P, Sarosiek I, Forster J: Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol 2005;3:49–54.
[PubMed]
https://doi.org/10.1016%2FS1542-3565%2804%2900605-6
6.
Oubre B, Luo J, Al-Juburi A, Voeller G, Familoni B, Abell TL: Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: long-term outcome. South Med J 2005;98:693–697.
[PubMed]
https://doi.org/10.1097%2F01.smj.0000168660.77709.4d
7.
Lin Z, Hou Q, Sarosiek I, Forster J, McCallum RW: Association between changes in symptoms and gastric emptying in gastroparetic patients treated with gastric electrical stimulation. Neurogastroenterol Motil 2008;20:464–470.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2982.2007.01054.x
8.
Andersson S, Lonroth H, Simren M, Ringstrom G, Elfvin A, Abrahamsson H: Gastric electrical stimulation for intractable vomiting in patients with chronic intestinal pseudoobstruction. Neurogastroenterol Motil 2006;18:823–830.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2982.2006.00801.x
9.
Gourcerol G, Leblanc I, Leroi AM, Denis P, Ducrotte P: Gastric electrical stimulation in medically refractory nausea and vomiting. Eur J Gastroenterol Hepatol 2007;19:29–35.
[PubMed]
https://doi.org/10.1097%2F01.meg.0000250584.15490.b4
10.
Maranki JL, Lytes V, Meilahn JE, Harbison S, Friedenberg FK, Fisher RS, Parkman HP: Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis. Dig Dis Sci 2008;53:2072–2078.
[PubMed]
https://doi.org/10.1007%2Fs10620-007-0124-7
11.
Lin Z, Sarosiek I, Forster J, McCallum R: Predictors of symptom non-responders to high-frequency gastric electrical stimulation for refractory gastroparesis. Gastroenterology 2006;130:A246.
12.
Ayinala S, Batista O, Goyal A, Al-Juburi A, Abidi N, Familoni B, Abell T: Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 2005;61:455–461.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2805%2900076-3
13.
Abell T, Thompson J, Johnson W, Minocha A: Double blinded randomized study of temporary gastric electrical stimulation (GES): preliminary results of the Endostim study (endoscopic stimulation temporarily implanted mucosally). Gastroenterology 2007;132:A113.
https://doi.org/10.1053%2Fj.gastro.2006.10.017
14.
Elfvin A, Andersson S, Abrahamsson H, Edebo A, Simren M, Lonroth H: Percutaneous implantation of gastric electrodes: a novel technique applied in animals and in patients. Neurogastroenterol Motil 2007;19:103–109.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2982.2006.00858.x
15.
Abidi N, Starkebaum WL, Abell TL: An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation. Neurogastroenterol Motil 2006;18:334–338.
[PubMed]
https://doi.org/10.1111%2Fj.1365-2982.2006.00765.x
16.
Abrahamsson H, Andersson S, Ringström G, Simrén M, Lönroth H: Experience with change of stimulation settings in patients (pts) with gastric electrical stimulation (GES). Gastroenterology 2007;132:M1165.
https://doi.org/10.1053%2Fj.gastro.2007.02.022
17.
Gryback P, Hermansson G, Lyrenas E, Beckman KW, Jacobsson H, Hellstrom PM: Nationwide standardisation and evaluation of scintigraphic gastric emptying: reference values and comparisons between subgroups in a multicentre trial. Eur J Nucl Med 2000;27:647–655.
[PubMed]
https://doi.org/10.1007%2Fs002590050558
18.
Thelin Schmidt P, Abrahamsson H, Dolk A, Hausken T, Karling P, Lindberg G, Nyhlin H, Ohlsson B, Simren M, Sjolund K, Stotzer P, Tornblom H: Methods to assess gastric motility and sensation. Scand J Gastroenterol 2008;43:1285–1295.
[PubMed]
https://doi.org/10.1080%2F00365520802240263
19.
Stotzer PO, Fjalling M, Gretarsdottir J, Abrahamsson H: Assessment of gastric emptying: comparison of solid scintigraphic emptying and emptying of radiopaque markers in patients and healthy subjects. Dig Dis Sci 1999;44:729–734.
[PubMed]
https://doi.org/10.1023%2FA%3A1026609808495
20.
Sadik R, Abrahamsson H, Stotzer PO: Gender differences in gut transit shown with a newly developed radiological procedure. Scand J Gastroenterol 2003;38:36–42.
[PubMed]
https://doi.org/10.1080%2F00365520310004939
21.
Strid H, Simren M, Stotzer PO, Abrahamsson H, Bjornsson ES: Delay in gastric emptying in patients with chronic renal failure. Scand J Gastroenterol 2004;39:516–520.
[PubMed]
https://doi.org/10.1080%2F00365520410004505
22.
Björnsson ES, Abrahamsson H: Interdigestive gastroduodenal manometry in humans: indication of duodenal phase III as a retroperistaltic pump. Acta Physiol Scand 1995;153:221–230.
[PubMed]
https://doi.org/10.1111%2Fj.1748-1716.1995.tb09857.x
23.
Björnsson ES, Abrahamsson H: Contractile patterns in patients with severe chronic dyspepsia. Am J Gastroenterol 1999;94:54–64.
[PubMed]
© 2010 S. Karger AG, Basel
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