Gastroelectrical stimulation for gastroparesis

A meta-analysis of 4 studies including 169 patients with diabetic gastroparesis treated by gastroelectrical stimulation (part of a systematic review of 601 patients) reported improvement in total symptom severity score (weighted mean difference 8.96 [95% confidence interval {CI} 6.1 to 11.8]; p<0.00001; I²=68.6%). A meta-analysis of 3 studies including 58 patients with idiopathic gastroparesis treated by gastroelectrical stimulation reported improvement in total symptom severity score (weighted mean difference 7.5 [95% CI 5.4 to 9.7]; p<0.00001; I²=52.9%). A meta-analysis of 2 studies including 33 patients with post-surgical gastroparesis treated by gastroelectrical stimulation reported improvement in total symptom severity score (weighted mean difference 8.3 [95% CI 5.5 to 11.1]; p<0.00001; I²=0%). Length of follow-up was unclear in all the analyses.

A meta-analysis of 7 studies including 378 patients with diabetic, idiopathic or post-surgical gastroparesis treated by gastroelectrical stimulation (part of a systematic review of 601 patients) reported a statistically significant improvement in gastric emptying at 4 hours (assessed using standardised radionucleotide scans of a solid meal: weighted mean difference 13.0 [95% CI 7.4 to 18.6]; p<0.00001; I²=87.4%). Subgroup analysis showed that the improvement was statistically significant in patients with diabetic or idiopathic gastroparesis but not in patients with post-surgical gastroparesis. Length of follow-up was unclear in all the analyses.

In a systematic review of 364 patients, a meta-analysis of 4 studies including 75 patients with gastroparesis treated by gastroelectrical stimulation reported no statistically significant change in weight (weighted mean difference 3.7 [95% CI -0.2 to 7.6]; I²=0%). Length of follow-up was not reported but 12-month outcomes were preferred.

In the systematic review of 364 patients, a meta-analysis of 8 studies including 184 patients with gastroparesis treated by gastroelectrical stimulation reported a reduction in need for nutritional support from 44% (96 out of 216) of patients at baseline to 11% (21 out of 184) at follow-up (odds ratio 5.5 [95% CI 2.8 to 11.1]; p<0.00001; I²=27%). Length of follow-up was not reported but 12-month outcomes were preferred.

A randomised controlled trial (RCT) of 32 patients with gastroparesis of idiopathic origin reported that there was a significant reduction in weekly vomiting frequency from 61 to 87% (p<0.001) and improvements in gastroparesis symptoms, gastric emptying and days of hospitalisation (all p<0.05) at 1-year follow-up.

The systematic review of 364 patients reported a significant improvement in Short Form-36 physical component score (weighted mean difference 8.1 [95% CI 5.0 to 11.1]) and the mental component score (weighted mean difference 8.16 [95% CI 4.9 to 11.5]), based on meta-analyses of 4 studies with 78 patients. The difference was statistically significant (p<0.00001) for both outcomes with no heterogeneity. Length of follow-up was not reported but 12-month outcomes were preferred.

The specialist advisers listed key efficacy outcomes as reduced symptoms, reduced need for nutritional support, improved nutritional status and reduced frequency of hospital admissions.