Expanding Indications of Gastric Electrical Stimulation

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Gastroparesis is a chronic motility disorder that delays, in the absence of mechanical obstruction, the occurrence of gastric emptying. The most common forms come with idiopathic, diabetic , and post-surgical complications. Delayed gastric emptying has been focused on as the main pathophysiologic abnormality manifested by gastroparesis. Other mechanisms, including loss of neuronal nitric oxide synthase and loss of the interstitial cells of Cajal, are coming to be widely recognized. 1 The operative mechanisms of gastric motility are heterogeneous and only incompletely understood. Current medical treatment options are classified as either prokinetics or symptom modulators such as antiemetics. 2 Unfortunately, these have failed to effect any remarkable progress in the last 30 years. A promising alternative treatment option for medically re-fractory gastroparesis is gastric electrical stimulation (GES). In the late 1990s, GES-manipulated gastric pacing improved symptoms in patients with gastroparesis and accelerated gastric emptying. 3 Later, in 2003, surgical insertion of a pair of electrodes with subcutaneous positioning of a neurostimulator in the abdominal wall reduced vomiting frequency in gastroparetic patients. 4 Then, in 2005, placement of temporary GES electrodes via both endoscopic and percutaneous endoscopic gastrostomy showed rapid, significant, and sustained symptom improvement in patients with refractory gasroparesis. 5 Apart from gastro-paresis, GES will be clinically significant therapy in the treatment for morbid obesity. GES for 6 months improved glucose control, and induced weight loss in obese type 2 diabetes patients. 6 Fecal incontinence, and constipation can be possible clinical applications using electrical stimulation of the gastrointestinal tract. 7 In this issue of the Journal of Neurogastroenterology and Motility, Singh et al 8 report on the effects of temporary GES in gastro-paresis-like syndrome (GLS). The aim of their prospective study was to explore the effects of endoscopy-based temporary GES in patients showing symptoms of gastroparesis with non-delayed gastric emptying. First, the authors tried temporary GES as a therapeutic op