Conservative GES Parameters Correlate With Optimal and Sustained Symptomatic Control in Gastroparesis

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Investigators sought to identify the “optimal parameters” for gastric electrical stimulation and determine whether they are associated with improved symptoms and long-term clinical outcomes in patients with gastroparesis.

A conservative approach to setting gastric electrical stimulation (GES) parameters was found to yield optimal and sustained symptomatic control in patients with gastroparesis regardless of etiology, according to research presented at the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting.

Investigators sought to evaluate the differences in GES parameters and gastroparesis total symptom score (TSS) in 2 etiological groups of patients with gastroparesis (N=57) at the initiation of GES therapy and during follow-up visits.  At each follow-up visit, the GES parameters for voltage and current were adjusted based on the patient’s clinical presentation and recorded impedance value.

The default stimulation parameters that remained constant were frequency of 14 Hz, pulse width of 330 μs, and an ON/OFF time of 0.1 s/5 s. The variable stimulation parameters were voltage, impedance/resistance, and current. A 5-point Likert scale (0-4) was used to assess vomiting, nausea, early satiety, bloating, postprandial fullness, and abdominal pain. The researchers calculated TSS by adding the scores of the 6 gastroparesis symptoms (maximum score, 24).

Gastroparesis etiology was diabetes mellitus in 72% of the cohort and idiopathic in 28%. The mean duration of gastroparesis before GES was assessed (6±4 years), as was the median time of follow-up visit (47 months [range, 5-73 months]). The investigators also calculated the mean patient age (44±14 years) in the study population, which was mostly made up of women (72%).

The investigators observed a significant decrease within each individual symptom score and the TSS during patients’ most recent follow-up visit compared with the baseline (P <.0001 for all individual symptom scores). At the initiation of GES therapy, the TSS was 18.8; at the most recent follow-up, it was 7.7 (P <.0001).

Impedance (P ≤.0001), voltage (P ≤.0001), and current (P ≤.0001) increased significantly in the follow-up visit vs the baseline visit. Specifically, impedance increased by 15% (515.1 to 598.4); voltage, by 42% (3.3 to 4.8); and current, by 26% (6.5 to 8.4).There were no significant differences in GES parameters in either etiological group.

These findings suggest that a conservative approach to setting GES parameters yields optimal and sustained symptomatic control in gastroparesis patients regardless of their etiology,” the study authors concluded. “This ‘classic’ programming of the system prevents early depletion of the device batteries, which allows longer utilization of GES therapy.”

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Willauer AN, Espino K, Alvarado L, et al. Optimal parameters of gastric electrical stimulation for long-term symptom control in patients with gastroparesis. Poster presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. P2790.