Placement of Gastric Neurostimulator Results in Reduced Symptoms and Rates of Hospitalization in Patients with Medically-Refractory Gastroparesis

Introduction: Gastroparesis (GP), which includes idiopathic (IGP) and diabetic (DGP) etiologies, is a disease of delayed gastric emptying without mechanical obstruction. Initial management focuses on medical optimization to control symptoms. Surgical options may be pursued in refractory cases, such as gastric electrical stimulation (GES) and laparoscopic pyloroplasty (LP), but studies on postoperative outcomes are limited. This study aims to elucidate the outcomes of patients who underwent operation for refractory GP. Methods: We conducted a single-center study of 100 consecutive adult patients with refractory GP who underwent GES and/or LP. A prospective survey assessing symptom changes and hospitalization frequency was administered at follow-up. Chart review supported the clinical data for initial surgical evaluation and postoperative outcomes. Results: 44 patients (19 with IGP, 25 with DGP) responded to the survey. Most (84%) were female with a mean age of 49 years. All patients reported intractable symptoms despite conservative and pharmaceutical (glycemic control, prokinetic, antiemetic) approaches. 26 patients underwent both GES and LP (GES/LP), 15 had GES-only, and two had LP-only. 93% and 74% of GES-only and GES/LP patients, respectively, reported an overall decrease in symptoms after operation. Postoperative hospitalization rates decreased significantly in GES-only patients (89% of DGP, 80% of IGP) and GES/LP patients (71% of DGP, 56% of IGP). Serum hemoglobin A1c levels dropped 0.8% in all patients who underwent GES (p=.099). Conclusion: Patients with refractory GP who either underwent GES-only or GES/LP showed symptom reduction and decreased hospitalization rates.