Gastric Electrical Stimulation in Intractable Nausea and Vomiting: Assessment of Predictive Factors of Favorable Outcomes

• Published in: Journal of the American College of Surgeons Vol. 209; no. 2; pp. 215 - 221
• Main Authors: Gourcerol, Guillaume, MD, PhD, Chaput, Ulriikka, MD, LeBlanc, Isabelle, MD, PhD, Gallas, Syrine, MD, Michot, Francis, MD, PhD, Leroi, Anne Marie, MD, PhD, Ducrotte, Philippe, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2009; Elsevier
• Subjects: Biological and medical sciences; Electric Stimulation Therapy - instrumentation; Electric Stimulation Therapy - methods; Female; Gastric Emptying - physiology; General aspects; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nausea - therapy; Prostheses and Implants; Quality of Life; Surgery; Treatment Outcome; Vomiting - therapy; Weight Gain; GES; gastric electrical stimulation; body mass index; GIQLI; T1/2; gastric emptying half-time; Quality of LIfe; Gastrointestinal Quality of Life Index; gastric emptying; GE; BMI; QOL; Medicine; Stomach; Prognosis; Treatment; Digestive system; Vomiting; Surgery; Electrical stimulus; Digestive diseases; Evolution; Nausea; Predictive factor
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2009.04.009

Background Gastric electrical stimulation (GES) represents a new therapy in patients with intractable vomiting and nausea. We aimed to determine preoperative factors associated with positive response during GES. Thirty-three consecutive patients received implants for medically refractory nausea or vomiting or both. Study Design Symptoms, Quality of Life (QOL), and gastric emptying (GE) were monitored before and 6 months after implantation. Compared with baseline, dyspeptic symptoms including nausea and vomiting, and QOL all improved at 6 months, yielding a significant weight gain while the GE rate remained unchanged. Twenty-four patients reported improvement; nine remained unimproved at 6 months. Results In multivariate analysis, baseline QOL and appetite alterations were predictive of improvement; previous history of gastric surgery was associated with failure. Surprisingly, patients with initial delayed GE (21 of 33) displayed similar improvement compared with patients with normal GE. Likewise, basal GE was not found to be predictive of positive outcomes, QOL, or symptoms improvement. Conclusions Patients with severe symptoms and altered QOL at inclusion particularly benefit from GES; delay in GE is not predictive of positive outcomes. This suggests that indication for GES should be based on clinical settings rather than initial GE, and then possibly extended to patients with normal GE.