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• W2921851950 abstract "Introduction: Gastroparesis is a complex disorder defined by delayed gastric emptying in the absence of gastric outlet obstruction or ulceration. Effective treatment is scarce and limited due to side effects. Gastric electrical stimulation (GES) is considered for compassionate use of refractory symptoms. Case: A 47-year old black female with diabetic gastroparesis status post GES implantation 5 years ago returned to clinic for worsening symptoms of nausea, vomiting, and epigastric pain. She had lost 3 kg in the past 3 months. In the week prior, she was unable to tolerate oral intake prompting 3 ER visits. Each time she was given IV antiemetics and discharged after symptom improvement. Stimulator interrogation showed normal function, not requiring adjustments. Labs revealed potassium 3.1 mEq/L and glucose 458 g/dL. Abdominal x-ray (AXR) showed a stimulator overlying the iliac crest with displaced leads (Fig. 1). Urgent EGD revealed 5 cm LA D esophagitis, 500 mL of bilious fluid, and gastric stimulator lead extruding through the gastric body mucosa to the pylorus into the duodenal bulb (Fig. 2). An ulcer was noted at the site of lead extrusion. The serosal bumper was lodged in the duodenal bulb, causing a ball-valve effect and resultant intermittent gastric outlet obstruction. The bumper was then snared into the stomach. Surgery was consulted and the patient underwent laparoscopic and endoscopic removal of all gastric stimulator parts (lead wires, plastic bumpers, and subcutaneous port). She was then placed on temporary high-dose acid suppression. Her symptoms dramatically improved, she tolerated oral intake, and was discharged home. During followup 6 weeks later, her symptoms remained controlled without hospitalization. Discussion: GES devices were FDA-approved in 2000 for refractory symptoms of gastroparesis of diabetic or idiopathic etiology. Two leads are implanted in the stomach muscle wall to deliver low electrical stimulation to the lower gastric nerves. Low-frequency stimulation is believed to affect vagal afferent nerves and decrease symptoms, mainly nausea in diabetic gastroparesis patients. Adverse event rates range from 5-10% and include infection, lead dislodgement, and bowel obstruction. We highlight the importance of recognizing complications of GES placement presenting with worsening symptoms of gastroparesis. AXR should be obtained and compared with initial AXR to check for lead displacement, and if so, prompt endoscopy should be performed.1890_A Figure 1. Abdominal x-ray showing the stimulator (A) in correct position, 1 year after implantation, and (B) displaced five years later, upon clinical presentation.1890_B Figure 2. Upper endoscopy revealing esophagitis and displaced gastric stimulator lead." @default.
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• W2921851950 date "2018-10-01" @default.
• W2921851950 modified "2023-09-27" @default.
• W2921851950 title "GOO Due to Gastric Stimulator Electrode Migration: Add This to Your DDx of Gastroparesis Exacerbation" @default.
• W2921851950 doi "https://doi.org/10.14309/00000434-201810001-01890" @default.
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