Prior Abdominal Surgery Does Not Impair Clinical Response to Gastric Electrical Stimulation in Gastroparesis Patients Followed for Up to Five Years

Introduction: Many patients with gastroparesis have had prior abdominal surgery. Gastric electrical stimulation (GES) is approved by the FDA for the treatment of medically refractory gastroparesis. It is unclear if the clinical response to GES is diminished in patients with prior abdominal surgery. We sought to determine if the clinical response to GES differs among gastroparesis patients with prior abdominal surgery. Methods: Fifty-three patients with gastroparesis (n=53, diabetic=33, idiopathic=16, and post-surgical= 4) treated with GES therapy were retrospectively evaluated. Patients were seen approximately every 3 months after GES. Symptoms were assessed by a modified gastroparesis cardinal symptom index (GCSI) that inquired about vomiting, nausea, bloating, early satiety, and post-prandial fullness. Abdominal pain and epigastric burning were also assessed. Values were obtained at baseline and at 1, 3, and 5 years. Results: Of the 53 patients with gastroparesis, 37 (70%) had prior abdominal surgery. 26/37 (70%) were laparoscopic (22 cholecystectomy, 3 appendectomy, 1 diagnostic). 11 were open (multiple surgeries including cholecystectomy, total colectomy, volvulus repair, and lysis of adhesions). 1 year after GES the GCSI score and vomiting improved significantly in both groups (Table 1). Among patients with prior abdominal surgery, the decrease in nausea and vomiting was sustained at 3 and 5 years after GES when compared to baseline (p=0.03 and p=0.05) and (p=0.013 and p=0.02), respectively. Among patients with no abdominal surgery, early satiety and postprandial fullness improved significantly at 1 year (p=0.01 and p=0.01) and this was sustained at 3 years post implant (p=0.05 and p=0.01), respectively.Table 1Conclusion: GES therapy significantly improves vomiting and nausea in patients with gastroparesis at 1, 3 and 5 years. Prior abdominal surgery did not adversely affect the clinical response to GES therapy.