Dr. Kolachalam, Gastric Electrical Stimulation (GES)
For your patients who have chronic nausea and vomiting from gastroparesis, finding the right treatment can be challenging. When symptoms are refractory, expand your treatment options by evaluating whether your patient is a candidate for GES. Non-surgical options such as diet changes, medicines, or other therapies should be discussed before choosing surgical options such as GES or Gastrectomy. GES is reversible, Gastrectomy is permanent, and both have risks.
What is Gastroporesis?
Gastroparesis is also called delayed gastric emptying. The term “gastric” refers to the stomach.
Normally, the stomach empties its contents in a controlled manner into the small intestines. In gastroparesis, the muscle contractions (motility) that move food along the digestive tract do not work properly and the stomach empties too slowly.
There is no cure for gastroparesis, but treatment with GES may help control its most debilitating symptoms, chronic vomiting and nausea. Here is a Gastroporesis PDF to learn more about Gastroporesis.
What causes Gastroporesis?
There are a number of things that may contribute to or cause gastroparesis. In the majority of people with gastroparesis, the cause is unknown and is termed “idiopathic.” Some people with idiopathic gastroparesis report symptoms following a virus infection (post-infectious or post-viral gastroparesis).
Other possible causes include:
- Diabetes–> most common known cause of gastroparesis. The cause of symptoms is probably due to damage to nerves that supply the stomach.
- Surgeries–> Most often these include nerve damage following esophageal or upper abdominal surgeries.
- Medications–>can impair motility. Examples include:
- narcotic pain relievers
- anticholinergic/antispasmodic agents
- calcium channel blockers
- some antidepressants
- some medications for diabetes
- Other illnesses–> Systemic illnesses, neurologic diseases, or connective disorders, such as multiple sclerosis, Parkinson’s disease, cerebral palsy, systemic lupus, and scleroderma are associated with gastroparesis. The cause and effect is unclear.
- Cellular changes–> changes in the cells which help control muscular contractions (motility) in the stomach. These are known as the interstitial cells of Cajal (ICCs). These cells probably represent the essential pacemakers of the entire gastrointestinal (GI) tract.
What is Gastric Electric Stimulation?
Gastric electrical stimulation is an FDA-approved approach to treating patients with chronic, intractable (drug-refractory) nausea and vomiting secondary to gastroparesis of idiopathic or diabetic origin.
Gastric electrical stimulation with the GES system helps control the chronic nausea and vomiting associated with gastroparesis by stimulating the smooth muscles of the lower stomach. A small, battery-powered gastric neurostimulator is implanted beneath the skin in the lower abdominal region. Leads deliver mild, controlled electrical pulses to the antrum portion of the stomach muscle wall. The system is programmed to optimize therapy for the individual patient.
What is the biggest impact Nausea & Vomiting has on my life?
People with gastroparesis have a variety of upper gastrointestinal symptoms including:
- chronic nausea
- frequent vomiting
- early satiety
- abdominal bloating
- abdominal pain.
These symptoms prevent the person from eating normally and may lead to dehydration, weight loss, and eventually life-threatening electrolyte imbalances and malnutrition. The impact on work, school, family, and activities is devastating for people.
Over time, high blood glucose levels and their metabolic effects can damage the vagus nerve and interfere with normal function. Inconsistent stomach emptying and poor absorption make blood sugar levels hard to control.
How can Gastric Electrical Stimulation help me?
Prospective clinical studies show that GES may significantly reduce vomiting frequency in patients with gastroparesis of idiopathic or diabetic origin.
GES may also deliver significant improvement in health-related quality of life.
The American College of Gastroenterology recommends GES for compassionate treatment in people with refractory symptoms of gastroparesis, particularly nausea and vomiting.
What are the risks?
GES does not work for everyone and requires surgery that also has risks which may include:
- infection at the implant site
- bleeding at the implant site
- bruising at the implant site
- pain at the implant site
What could prevent success or cause unfavorable results?
Adverse events related to the GES system may include:
- implant site pain
- lead penetration
- bowel obstruction or perforation
- lead entanglement or erosion
- irritation/inflammation over implant site
- device mechanical or electrical problems
Any of these situations may require additional surgery or cause return of symptoms. The video below has a cartoon of how the GES technology works and also repeats information above.
What do you do after the implant is placed?
Come in for a follow-up appointment to ensure GES is giving you the optimal therapy outcomes intended, confirm the GES pacemakers integrity and performance, and measure neurostimulator battery life. A recommended schedule of visits is 1, 3, 6, and 12 months after surgery and at least every 12 months thereafter.
The following actions are what can be expected at each follow-up visit:
- Interrogate the neurostimulator to check programmed parameters and values, battery status, how much your using the GES, and electrode impedance.
- Measure changes in your symptoms
- Assess blood glucose levels if you have diabetes
- In some cases, reprogramming may be needed if new symptoms are not reversible. Possibly keeping a symptom diary to monitor changes in your symptoms.