Gastric Electrical Stimulation for the Treatment of Gastroparesis: Ready for Prime Time?

stimulator, using low-amplitude and high-frequency stimulation, which received the Food and Drug Administration approval as a humanitarian device in March 2000 (Enterra; Medtronic, Minneapolis, Minn., USA), provided a potentially attractive alternative for medical or surgical treatment of difficult gastroparesis. To date, the beneficial effects of GES that have been reported from uncontrolled case series include improvements in nutritional status and symptoms of nausea and vomiting as well as improved quality of life [6–14] . In addition, a pilot study on the use of GES in patients with postgastric surgery gastroparesis showed improvements in symptoms and gastric emptying times at 1-year followup [15] . Favourable results with the use of GES in patients with intractable vomiting regardless of whether gastric emptying was delayed or normal have been recently reported [16] . However, many of these reports have included small patient numbers ( ! 30) [6–8, 11, 14–16] , and in an uncontrolled use, the results may be influenced by a natural history with spontaneous improvement and by placebo effects. In addition, there are insufficient longterm data, with only two studies [14, 17] providing 3-year results. In this issue, Anand et al. [18] report on the largest series of 214 patients with drug-refractory gastroparesis followed up for a median duration of 4 years in three regional centres. The patients were divided into three Gastroparesis is a symptomatic chronic disorder of gastric motility characterized by severely and chronically delayed gastric emptying without any evidence of mechanical obstruction [1] . The clinical presentation can vary from mild intermittent nausea to refractory vomiting, chronic abdominal pain, and a compromised nutritional state. In severe cases, total parenteral nutrition or a feeding jejunostomy may be required. Poorly controlled symptoms often lead to frequent hospital visits and contribute to an impaired quality of life. The treatment of gastroparesis remains a clinical challenge. The currently available standard medical therapy is based on the use of anti-emetics and prokinetic agents, although the evidence for the efficacy of this therapy is not impressive. In addition, based on uncontrolled studies, intrapyloric injection of botulinum toxin seems able to relieve the symptoms of gastroparesis [2, 3] , but preliminary controlled data do not confirm efficacy [4] . Where medical therapy fails, surgery is considered, and there are anecdotal reports of favourable outcomes with creation of a stoma, to provide access for enteral nutrition and decompression, or with major gastric resections reserved as a last resort [5] . In the light of the unsatisfactory results from conventional medical therapy, there has been growing interest in the use of gastric electrical stimulation (GES) as a treatment option. The development of an implantable gastric Published online: May 18, 2007