Factors Affecting Patient Outcome, Following Surgical Insertion of Gastric Electrical Stimulator for Gastroparesis – 10 Year Experience in a Single UK Centre

Background: Drug refractory gastroparesis is a debilitating disorder associated with severe nausea and vomiting, resulting in a negative impact on quality of life. High frequency gastric electrical stimulation (GES) is a viable, alternative treatment with a reported success rate of between 50 and 70%. This study looks at the factors affecting outcome that may help in improved patient selection. Patients and Methods: Clinical data from 48 patients with severe, intractable gastroparesis, (12 diabetic and 36 idiopathic) were studied. The median age of the patient group was 36 years (range 15-80). There were 38 females (79%). GES was inserted via an open technique in 30 cases (62%) and by conventional, or robotic assisted laparoscopic technique, in 18 cases. A history of preoperative use of opioids for severe abdominal pain was noted in 18 patients (37.5%). Outcome was measured by changes in quality of life and severity of symptoms (QOL/SF-36 and TSS-total symptoms score). Fisher's exact test was used to analyze the association between patient-related factors and outcomes. Results: 36 out of 48 patients (76.6%) had significant improvement in TSS, especially in nausea and vomiting (>80% reduction) and QOL after GES insertion at follow-up. There was no significant, statistical difference between long-term outcomes in aetiology, age, sex of the patient or surgical technique (p= n.s.). However, patients who were not on opiates prior to surgery had significantly better long-term outcomes than those on opiates (p= 0.0018). Conclusion: Our study demonstrates that GES is effective in patients with drug refractory gastroparesis. However, patients on opiates prior to surgery do less well following GES. GES therefore, appears to be more effective in patients who have nausea and vomiting as the predominant symptoms than those with abdominal pain