Gastroparesis When Gastric Electrical Stimulation Has Not Adequately Controlled Symptoms

Clinical scenario

This protocol applies to patients with gastroparesis who have already undergone gastric electrical stimulation (GES) — used as a humanitarian device for medically refractory disease — and whose symptoms remain insufficiently managed. When vomiting frequency is not meaningfully reduced and overall gastroparesis symptoms persist despite GES, a defined next step is indicated.

Prior treatment — failure condition

Gastric electrical stimulation (GES) was the previous line of care. The goals it was expected to achieve — decreased vomiting frequency and control of gastroparesis symptoms — were not reached to an adequate degree. This failure to meet those targets is the trigger for escalation to the current protocol.

Next approach (partial overview)

The approach at this stage involves an endoscopic interventional procedure directed at the pylorus, aimed at symptom control. The clinical goals are relief of gastroparesis symptoms and improved gastric emptying. The complete structured protocol — including patient selection considerations, procedural specifics, and decision criteria — is available via the link below.

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References

DOI: 10.14309/ajg.0000000000001874

In patients with GP with symptoms refractory to medical therapy, we suggest pyloromyotomy over no treatment for symptom control (conditional recommendation, low quality of evidence).

A recent study has identified benefit in relief of symptoms as well as improved GE with G-POEM procedure followed for 6 months in a sham-controlled study (173).

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