Diabetic Gastroparesis: What to Do When Gastric Electrical Stimulation Has Not Controlled Symptoms

This protocol addresses gastroparesis occurring in a patient with diabetes mellitus — a specific subpopulation in which glycaemic status and symptom burden are closely intertwined. When a prior procedural intervention has been tried and key symptom targets remain unmet, a defined next step exists.

Clinical Scenario

Diabetic gastroparesis carries distinct management considerations. Optimal glucose control is an important component of care, with evidence suggesting it may reduce the risk of further gastroparesis progression in this population.

Previous Treatment — Goals Not Achieved

Gastric electrical stimulation (GES), used as a humanitarian device for medically refractory gastroparesis, did not achieve adequate decrease in vomiting frequency or satisfactory control of gastroparesis symptoms. This unmet response is the trigger for escalation to the present protocol.

Next-Line Approach (Partial — Full Protocol Below)

The protocol involves a procedural intervention targeting the pylorus to address the underlying motility dysfunction driving symptoms.

Specific procedure, patient selection criteria, technical details, and post-procedure management are in the full protocol.

Treatment Goals

Relief of gastroparesis symptoms
Improved gastric emptying

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000001874

In patients with diabetic gastroparesis (DG), optimal glucose control is suggested to reduce the future risk of aggravation of GP (conditional recommendation, low level of evidence).

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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