Gastric electrical stimulation for refractory gastroparesis: predictors of response and redefining a successful outcome.

Gastroparesis is a syndrome of delayed gastric emptying in the absence of mechanical obstruction.1 Symptoms include early satiety, postprandial fullness, nausea, vomiting, bloating, and abdominal pain. Gastroparesis significantly affects patients’ quality of life, increases health care costs through hospitalizations and treatment costs, and is associated with significant morbidity for affected patients. Common etiologies include diabetes (29%), idiopathic (36%), and postsurgical causes (13%).2 High-frequency, low-intensity gastric electrical stimulation (GES) (Enterra™; Medtronic, Inc., Minneapolis, MN) has been shown in previously published literature to improve symptoms and quality of life in patients with medically refractory gastroparesis.3–8 However, the definition of what constitutes “improvement” in the literature is ill-defined and has lacked standardization in published studies to date. As a result, a significant amount of skepticism exists regarding the usefulness of GES in the treatment of gastroparesis.9, 10 We sought to define the degree of improvement in various subgroups of patients based on the degree of change in total symptom severity score (TSS) as well as patients’ perception of improvement, and to compare its effectiveness (as measured by these two benchmarks of treatment success) in patients with diabetic and idiopathic etiologies.