Gastric electrical stimulation (GES) is a medical device-based therapy that uses a small, implanted device to deliver mild electrical pulses to the stomach muscles. Much like a cardiac pacemaker, it influences the stomach’s electrical activity to provide relief for individuals with debilitating gastrointestinal issues unresponsive to other treatments.
Conditions Treated by Gastric Electrical Stimulation
Gastric electrical stimulation is primarily considered for individuals suffering from severe, drug-refractory gastroparesis. This condition involves delayed stomach emptying, where food remains in the stomach for an abnormally long time. Common forms include diabetic gastroparesis, linked to long-term diabetes, and idiopathic gastroparesis, where no identifiable cause is found.
Patients often experience chronic nausea, vomiting, early fullness, and bloating. When these symptoms persist despite dietary changes and various medications, GES may be considered. The therapy is reserved as a last-resort option after other medical and lifestyle interventions have proven ineffective. It aims to reduce the intensity and frequency of nausea and vomiting, often the most distressing symptoms.
The Surgical Implantation Procedure
The gastric electrical stimulation system consists of two main components: a neurostimulator and two leads. The neurostimulator is a small, battery-powered device, similar to a cardiac pacemaker. The leads are insulated wires transmitting electrical pulses from the neurostimulator to the stomach.
The surgical procedure for implanting the device is performed using a minimally invasive laparoscopic technique. The neurostimulator is placed in a small pocket under the skin, usually in the lower abdominal region. The two leads are then carefully attached to the outer muscle wall of the stomach. This placement allows the device to deliver targeted electrical impulses to the stomach muscles.
The procedure is performed under general anesthesia, ensuring patient comfort throughout. After the device components are securely in place, the incision is closed. The neurostimulator is activated and programmed by a clinician after a brief recovery period, allowing the patient to heal from the surgery before the stimulation begins.
Living with a Gastric Stimulator
After the implantation procedure, the gastric stimulator requires initial programming and subsequent adjustments by a clinician. These adjustments are performed externally using a handheld programmer, allowing customization of stimulation settings to the individual’s specific needs and symptom response without further surgery.
The neurostimulator unit contains a battery that has a lifespan ranging from 5 to 10 years. When the battery depletes, a minor surgical procedure replaces only the neurostimulator unit, leaving the leads in place. Individuals with a gastric stimulator should carry an identification card provided by the device manufacturer. This card contains important device information, useful for airport security screening and other medical situations.
Patients should also be aware of potential interactions with certain medical procedures. While some newer gastric stimulators are MRI compatible, many older models are not or require specific precautions. It is important to consult with a healthcare provider regarding any planned medical procedures to ensure safety and prevent device interference.
Expected Outcomes and Patient Candidacy
Gastric electrical stimulation primarily aims to alleviate the frequency and severity of chronic nausea and vomiting associated with gastroparesis. Patients often experience symptom reduction, leading to improvements in nutritional status and quality of life. While GES can significantly manage nausea and vomiting, it is often less effective for other symptoms like abdominal pain and bloating.
Ideal candidates have a confirmed gastroparesis diagnosis and have not found adequate relief from other medical therapies, including dietary modifications and medications. The device manages symptoms, rather than curing the underlying condition causing gastroparesis. The device is approved under the FDA’s Humanitarian Device Exemption (HDE) pathway, supporting devices for rare conditions.