Small case series of gastric stimulation for the management of transplant-induced gastroparesis.

摘要

BACKGROUND: Gastroparesis is a recognized complication following organ transplantation with incidences reported between 24 and 83%. Gastroparesis can complicate medical management in these patients leading to the inability to take medications and possibly chronic transplant rejection. Gastric electrical stimulation (GES) has been shown in both controlled and uncontrolled studies to reduce the frequency of nausea and vomiting and lead to weight gain in patients with gastroparesis refractory to standard medical treatment; however, there is little evidence to support the use of GES in transplant recipients. The goal was to evaluate the response of transplant patients with gastroparesis to GES and compare to nontransplant recipients. MATERIALS AND METHODS: A questionnaire consisting of 11 questions was administered to investigate symptoms. Patients were asked to score these symptoms before and after surgery using a 0-5 Likert scale. RESULTS: Thirteen consecutive patients underwent placement of the Enterra (Medtronic, Minneapolis, MN) device with a mean follow-up of 12 +/- 6.1 months. All three transplant patients (100%) reported an improvement in quality of life. Similarly, transplant patients were as likely as the diabetic or idiopathic patients to demonstrate improvements in symptoms of nausea, vomiting, and retching and prandial symptoms following Enterra therapy. In fact, transplant patients reported improvement in appetite and bloating symptoms more frequently than diabetics (P = 0.055 and P = 0.037, respectively). CONCLUSION: Posttransplantation gastroparesis responds to therapy with Enterra GES as well as in patients with idiopathic or diabetic gastroparesis. Enterra therapy should be prospectively investigated in this population of patients.