The Enterra Therapy System and Gastroparesis

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Dr. Buchin is the one of the only surgeons in the North Shore LIJ Health System and in Long Island to place gastric neurostimulators. This procedure is done in a minimally invasive fashion or laparoscopically.

Gastroparesis

Gastroparesis is a condition in which the muscles in your stomach don't function normally. It affects approximately 5 million people.

Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all, preventing your stomach from emptying properly. This can interfere with digestion, cause nausea and vomiting, and play havoc with blood sugar levels and nutrition. Living with gastroparesis also affects emotional well being—the constant discomfort of chronic nausea and vomiting can have an impact on school and work performance, family and personal relationships, and social activities.

Most patients present with upper-gastrointestinal symptoms or with symptoms related to disordered gastric motor function. These include:

· Nausea

· Vomiting

· Abdominal bloating

· Abdominal pain

· Feelings of fullness after only a few bites of food (early satiety)

· Heartburn or gastroesophageal reflux disease (GERD)

· Changes in blood sugar levels

· Lack of appetite

· Excessive weight loss

Treatment Options

There is no cure for gastroparesis, but several treatments are available that may improve symptoms and quality of life.

Nutrition Education/Diet Modifications

Patients are often initially treated with nutrition education and diet modifications. The purpose of diet modification is to reduce symptoms and maintain adequate fluids and nutrition. A modified diet typically consists of liquids, restricted fats and plant fiber, and frequent small meals.

Drugs

The most common drugs used to treat gastroparesis or its symptoms include :

Prokinetic drugs – used to improve the rate of stomach emptying

Antiemetic drugs – used to control nausea and vomiting but have no effect on stomach emptying

Enteral Nutrition

This therapy involves the delivery of liquid nutrients via a tube placed directly into the stomach or small intestine. Feeding tubes are usually temporary and used only when gastroparesis is severe.

Total Parenteral Nutrition

Total parenteral nutrition (TPN) supplies nutrients to a person’s bloodstream through an intravenous (IV) infusion. TPN is used only if enteral feeding is not tolerated or is insufficient to meet caloric needs.

Surgery

Surgery for gastroparesis is considered a treatment of last resort. One surgery, called pyloroplasty, involves widening of the pyloric valve (the muscle that separates the stomach from the upper region of the small intestine, which is called the duodenum).

Enterra Therapy—Gastric Electrical Stimulation

This surgical option is indicated for patients with chronic, drug-refractory (resistant to medication) nausea and vomiting due to gastroparesis of diabetic or idiopathic origin.

The Enterra neurostimulator is implanted beneath the skin and connected to two leads implanted in the stomach muscle.

Probable Benefits

Gastric electrical stimulation uses mild electrical pulses to stimulate the nerves and smooth muscles of the lower stomach. This may help to control the chronic nausea and vomiting associated with gastroparesis of diabetic or idiopathic origin when drugs haven't worked.

A clinical study (WAVESS – Worldwide Anti-Vomiting Electrical Stimulation Study) using the Enterra^® neurostimulator for treating nausea and vomiting has shown that most, but not all, patients have some relief of their vomiting symptoms.

Risks of Surgery

Implanting the gastric electrical stimulation system carries the same risks associated with any other gastric surgery. Risks may include:

· Infection

· Allergic response to implanted materials

· Temporary or permanent neurologic complications

· Pain at the surgery site

· Bruising at the neurostimulator site

Possible Side Effects

Side effects of gastric electrical stimulation of the stomach may include the following:

· Gastrointestinal (GI) symptoms

· Abdominal pain

· Feeding tube complications

· Difficulty swallowing

· Dehydration

· Acute diabetic complications

· Loss of therapeutic effect

Possible Device Complications

· There may be pain, lack of healing, or infection where the gastric electrical stimulation system parts are implanted.

· The gastric electrical stimulation system parts may wear through your skin, which can cause an infection or scarring.

· The Enterra neurostimulator could stop because of mechanical or electrical problems. Either of these would require surgery.

· Your body may have an allergic reaction to the gastric electrical stimulation system. Your body could also reject the system (as a foreign body).

· The lead may perforate your stomach, requiring surgery.

· There is the possibility of tissue damage resulting from the stimulation settings or a malfunction of one of the parts of the gastric electrical stimulation system.

Please discuss any concerns you have about potential risks, side effects, and complications of neurostimulation with your doctor.

Enterra & Gastroparesis

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