Performed by Jody Johnson, M.D.
Presentation by Jonathan Powell, M1
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Female
Type 1 diabetes has lead to peripheral neuropathy
◦ Resulted in gastroparesis
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Peripheral neuropathy: In this case the patient has
diabetic peripheral neuropathy in which the high
blood sugar levels damaged her peripheral nerves
◦ Can cause pain (or sometimes lack of sensation) and loss of
motor control
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A stomach disorder in which a full thickness loss of
cells of Cajal (neuroconducting cells of the
stomach) leads to a decrease in gastric emptying
Stomach muscles function poorly
◦ Food digested slowly, results in a lot of pain
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Common causes:
◦ Idiopathic in most cases
◦ Type 1 or 2 diabetes
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Proper nutrition/diet changes: restrict fats,
frequent but small meals, lots of fluids
Drugs:
◦ Prokinetic: improve rate of stomach emptying ex.
Methylnaltrexone
◦ Antiemetic: control nausea and vomiting, no effect of
stomach emptying ex. Prochlorperazine
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Surgery: the last resort
◦ Pyroplasty: widening of pyloric valve
◦ Gastric ESTIM
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Enterra neurostimulator
implanted beneath the
skin
Anode and cathode
implanted in wall of
stomach along the
Greater Curvature
Handheld programming
device is used to alter
the degree and frequency
of stimulation (catered to
each patient)
Effectiveness has not
been demonstrated
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Patient Position
Scissors
Marilyn dissector
O-suture
3-O silk R01 Suture
Debakey
Enterra neurostimulator
Two trochars (size 5)
One trochar (size 10)
Laparoscope
Hand held programming
device to set frequency
and degree of current
discharge by the device
Equipment Used
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Initial incisions: one
midline incision
between abdominal
quadrants one and two
for placement of scope
Two lateral incisions
for size 5 trochars (5s
are free)
◦ One in each abdominal
quadrant
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ID the pylorus
Deflate stomach
Mark point 10cm along
Greater Curve of
Stomach starting from
pylorus
Insert leads into
stomach wall
◦ Caudal lead at 9.5cm
from pylorus
◦ Rostral lead at 10.5 cm
from pylorus
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Make pocket at Left midquadrant for
subcutaneous placement
of battery
Externalize leads
Close up
Interrogation: device
that, when placed above
ESTIM site, can be used
to measure battery life
and set the current
released during each
discharge of the device
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Patient can be sent home that day
Possible complications:
◦ Pain, lack of healing, or infection where device was
implanted
◦ Parts of device could wear through skin
◦ Allergic rxn to device
◦ Leads may perforate your stomach or device components
may become entangled with or obstruct other internal
organs
◦ Tissue damage from improper stimulation setting or
malfunction
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Gastric ESTIM is no longer being performed
because the effectiveness of this procedure could
not be demonstrated
Currently, ESTIM procedures are used for maladies
such as:
◦ Xerostomia- dry mouth due to lack of saliva
 Intraoral electrostimulation device increases salivary output of Parotid
Gland
◦ Function electrical stimulation- use electrical stimulation to
activate peripheral nerves affected by paralysis from spinal
cord injury, head injury, stroke, etc
 Sometimes referred to as neuromuscular electrical stimulation
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Buckles, MD, Daniel, Jameson Forster, MD, and Richard McCallum, MD. "The
Treatment of Gastroparesis in the Age of the Gastric Pacemaker: A Review."
Medscape 5.4 (2003): 6. Web. 15 Apr 2011.
<http://www.medscape.com/viewarticle/460632>.
"About Gastroparesis." Medtronic. Medtronic Inc., 22 09 2010. Web. 15 Apr
2011. <http://www.medtronic.com/your-health/gastroparesis/index.htm>.
McCallum, MD, Richard, William Snape, MD, Fredrick Brody, MD, and John
Wo, MD. "Gastric Electrical Stimulation With Enterra Therapy Improves
Symptoms From Diabetic Gastroparesis in a Prospective Study." Clinical
Gastroenterology andHepatology 8.11 (2010): 947-954.e1. Web. 15 Apr
2011. <http://www.cghjournal.org/article/s1542-3565(10)005458/abstract>.
Douglas, David. "Electrostimulation Relieves Xerostomia." Medscape News
(2010): n. pag. Web. 15 Apr 2011.<
http://www.medscape.com/viewarticle/731503>.
Abell, MD, Thomas. "Gastric Electrical Stimulation for Medically Refractory
Gastroparesis." University of California San Francisco. University of California
San Francisco College of Medicine, 2003. Web. 15 Apr 2011.
<http://sadieo.ucsf.edu/course/old/Abell1.pdf>.