Temporary Percutaneous Gastric Electrical Stimulation: Significant Progress in the Treatment of Drug-Refractory Vomiting and Nausea

major step in the selection of good candidates for treatment of fecal incontinence by electrical stimulation of the sacral roots was to test the effect of temporary stimulation. This appeared to be a significant therapeutic progress [3] . In this issue of the journal, Andersson and colleagues, from Gothenburg, Sweden, report their experience with temporary percutaneous (TP) GES in 27 non-diabetic patients with intractable drug-refractory nausea and/or vomiting. With their technique, the implantation is guided by gastroscopy after transabdominal identification of the stomach position and the electrodes are inserted through the abdominal wall before being sewn into the gastric wall. To secure the electrode in the submucosa, the tip of the electrodes is T-shaped with a pair of flexible tines. The procedure seems simple, well tolerated and also safe, and no infection was reported despite a TP-GES of at least 2 weeks. The clinical impact of TP-GES is obvious as it allowed Andersson and colleagues to select 81% of the 27 possible candidates for definite implantation after increasing the intensity of stimulation from 5–7 to 8–10 mA in some patients. These results confirm those reported by Ayinala et al. [4] with orally or PEG-placed electrodes. Another question to answer about HF-GES is whether patients other than those with diabetic, idiopathic or postsurgical gastroparesis may benefit from the techThe relief of patients with chronic vomiting and/or nausea is a clinical challenge when symptoms are drugrefractory and have a significant impact on the nutritional status of the patient. A promising therapeutic approach in such cases is high-frequency (HF) gastric electrical stimulation (GES). The technique consists in delivering short (less than 1 ms) and HF (approximately fivefold higher than the basal gastric pacemaker rate) electrical pulses via two electrodes implanted in the wall of the gastric antrum. In patients unresponsive to a pharmacological approach by any type of prokinetics (including erythromycin), several studies have demonstrated the efficacy of HF-GES with the improvement of nausea and/or vomiting, and also other gastroparetic symptoms, nutritional parameters, quality of life and glycemic control in the subgroup of diabetic patients with gastroparesis. However, the technique is not always effective and predictive parameters for a therapeutic success remain to be precisely determined. If diabetic patients with gastroparesis appear to be good candidates for HF-GES, results are less convincing in some patients with idiopathic [1] or postsurgical gastroparesis [2] . Moreover, treatment by HF-GES is invasive with the need for a short stay in a surgical unit to implant the stimulator, while the cost of the device remains high. Therefore, careful selection of good candidates for this therapeutic option is important. A Published online: September 9, 2010