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Temple GI Implants 100th gastric electric stimulator

Physicians in Department of Medicine, Section of Gastroenterology

Temple University Hospital is becoming the premier center for GI motility disorders in the nation. Temple’s unique capabilities for complex conditions like gastroparesis, achalasia, chronic constipation and irritable bowel syndrome have attracted patients from all over the country.

Temple has unique experience treating gastroparesis - a disorder with delayed stomach emptying which is especially prevalent in patients with diabetes. Temple physicians have pioneered the use of the Enterra Gastric Electric Stimulator since 2000. Recently, they implanted their 100th device into a patient with gastroparesis.

“We have the most experience of any medical center on the East Coast when it comes to working with the Gastric Electric Stimulator,” says Henry P. Parkman, MD, Professor of Medicine and Director of Temple’s GI Motility Laboratory. “We evaluate several patients each week, and nationwide are in the top three centers when it comes to experience with this procedure.”

“With the rise in obesity, we are seeing an increasing proportion of patients with Type 2 diabetes as well,” says Dr. Parkman. “This ultimately equates to many more people with gastroparesis.”

Proper Evaluation

The key to appropriate treatment is proper evaluation of the electrical activity, pressure and transit time in the GI tract. Electrogastrography measures the electrical activity of the stomach. Antroduodenal manometry uses catheters to measure the pressures in the stomach and small intestine to evaluate coordination between the organs.

“We work with the Temple Department of Nuclear Medicine on the evaluations,” says Parkman. “They are truly pioneers in methods that measure gastric emptying and whole gut transit.” This further supports Temple’s ability to offer extensive testing that is not available at most hospitals.

First Line Medical Therapies

The first line treatment for gastroparesis includes an array of medications. Reglan and Zelnorm speed up gastric emptying. Compazine and Zofran ease nausea, and botulinum toxin injections relax the pylorus. These treatments can be very effective; however, a small percentage of patients will continue to experience severe symptoms. Temple patients have access to more unique treatments such as the gastric stimulator and the drug domperidone, which has been FDA approved for compassionate use by programs with authorization through an Investigational New Drug Application (IND).

An Option for Those with None

For patients whose symptoms persist despite medical therapies, the gastric stimulator may be an appropriate option. However, the gastric stimulator requires a surgical procedure and it is not right for everyone.

“These patients are in misery,” says Sean Harbison, MD, Professor of Surgery. “They get debilitating nausea, vomiting and pain. They can’t function and they tend to be in their thirties and forties and female. Their symptoms are completely debilitating and they are frequently admitted to the hospital. For them, the gastric stimulator can be life-changing.”

“We’ve found that patients with nausea and vomiting symptoms do very well,” adds Parkman. “In our experience about 60 percent of patients improve with the gastric stimulator and go back to living happier more productive lives.”

Patients with diabetes do best while those with idiopathic gastroparesis do less well.

“The one group who seem to do not quite as well are those who require chronic narcotic pain medicines,” says Parkman. “But it’s important when considering these statistics to remember that these patients have had no relief with other therapies.”

A Surgical Approach

The placement of the Gastric Electric Stimulator, which is essentially a gastric pacemaker, takes less than an hour under general anesthesia. It requires a three day hospital stay.

“We do the procedure as a laparotomy because we can do one very small subxiphoid incision and a two inch incision for the pacemaker,” says Harbison. “If we do the procedure laparoscopically, we have to make more incisions.”

The two electrical stimulator leads are attached onto the muscular wall of the stomach. Surgeons make sure they are placed correctly and test the stimulator to be certain it is functioning properly. As with any intra-abdominal procedure, there is a small risk of bowel obstruction. In addition, there can be some incisional pain.

“I have not seen any bowel obstructions, in our experience,” says Harbison. “We’ve had to remove three of the 100 stimulators that we placed due to the patients experiencing discomfort but two of the three were re-implanted because they experienced such good results in terms of symptom relief.”

Temple has developed unique expertise in the treatment of GI motility disorders and is one of only five centers nationwide to be designated a NIH Clinical Center for Gastroparesis. For more information about unique treatments for patient with Gastroparesis, call 1-800-TempleMed.

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By Ellen Pifer for Temple University Health System

April 5, 2007

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