Gastric electrical stimulation for intractable vomiting in patients with chronic intestinal pseudoobstruction

• Gastric electrical stimulation (GES) is effective for medically refractory nausea and vomiting in patients with idiopathic or diabetic gastroparesis (DGP). We studied whether GES has similar effects in chronic intestinal pseudoobstruction (CIP). Patients referred for chronic small bowel (SB) motor dysfunction requiring parenteral nutrition and having a weekly vomiting frequency (WVF) >/=7 refractory to prokinetics and antiemetics were included. Patients were implanted for high-frequency GES 12 stimuli min(-1), laparoscopy being the first-line implantation procedure. Results were compared with those obtained in 11 DGP patients. Three patients with familial CIP and one patient with postsurgical CIP fulfilled the criteria. Gastric emptying was delayed in two and was normal in two patients. SB transit time was markedly delayed. Laparoscopy was used in three patients, one patient required laparotomy. During GES, WVF decreased from 24 (mean) before GES to 6.9 at 12 months and 7.5 at last visit. Vomiting reduction was 50-90% at last visit. For the DGP patients, WVF decreased from 23 before GES to 3.5 at 12 months and 3.5 (P < 0.01) at last visit. In patients with CIP and medically refractory vomiting, GES seems to have an anti-vomiting effect comparable to that seen in patients with severe DGP. GES should be considered as a therapeutic option for these patients.

Nyckelord

Adult

Aged

80 and over

Chronic Disease

Diabetes Mellitus

*Electric Stimulation Therapy

Electrodes

Implanted

Female

Gastric Emptying/physiology

Gastrointestinal Motility/physiology

Gastroparesis/complications

Humans

Infant

Newborn

Intestinal Pseudo-Obstruction/*complications

Laparoscopy

Male

Manometry

Middle Aged

Nausea/etiology/therapy

Stomach/*physiology

Vomiting/*etiology/*therapy

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)