169 Riverside Drive, Binghamton, NY 13905
Gastroparesis: A Serious Digestive Problem
Gastroparesis is a stomach disorder in which food moves through the stomach more slowly than normal. In a healthy digestive system, strong muscular contractions move food from the stomach through the digestive tract; however, with gastroparesis, the stomach muscles work poorly (or not at all), thus preventing the stomach from emptying properly. Because it interferes with digestion, gastroparesis often results in severe, chronic nausea and vomiting, which can cause malnutrition and inadequate blood sugar levels. Living with gastroparesis also affects emotional well-being—the constant discomfort of chronic nausea and vomiting can have an impact on school and work performance, family and personal relationships, and social activities.
There is no cure for gastroparesis, but there are therapies that improve symptoms and offer hope for a better quality of life. One of these is Gastric Electrical Stimulation (GES). This implantable system is designed to relieve the symptoms of chronic, drug-refractory (resistant to treatment with medication) nausea and vomiting associated with gastroparesis of diabetic or idiopathic origin.
Gastric Electrical Stimulation
The Enterra® Therapy implant is designed to improve chronic, drug-refractory nausea and vomiting associated with gastroparesis of diabetic or idiopathic origin.
The system consists of a neurostimulator (about the size of a pocket watch – 2.2” high x 2.4” long x .4” thick) implanted beneath the skin, usually in the lower abdominal region. Two insulated wires are implanted in stomach muscle and then connected to the neurostimulator.
The neurostimulator sends mild electrical pulses through the leads to stimulate the nerves and smooth muscles of the lower stomach. This helps to control the chronic nausea and vomiting casued by gastroparesis.
Implanting the Stimulator
Implanting the gastric stimulator typically takes from 1 to 2 hours under general anesthesia. Dr. Pallapothu will discuss the surgery with you in detail and determine the best locations for incisions and placement of the neurostimulator and leads, based on your medical history, individual anatomy, and personal preferences. He will try to place the system in an area that is most comfortable for you so that you can maintain normal daily activities. The location should also be cosmetically acceptable to you. In addition, Dr. Pallapothu will follow special implant and programming considerations if you have another medical device already implanted.
Your implant will be inserted laparoscopically, using special surgical instruments that are inserted through tiny incisions to perform the procedure. During the implant, the electrode at the tip of each lead is placed in the muscle wall of your stomach. The lead bodies are then routed under your skin from the stomach to the neurostimulator and connected. The neurostimulator and leads are placed in a pocket formed just beneath your skin, usually below the rib cage and above the belt line in the lower abdominal region. the pocket is then sutured closed.
After the surgery, during an office visit, Dr. Pallapothu uses a handheld, external programmer to adjust the neruotimulator and customize therapy to achieve the best possible symptom control for you. Programming is noninvasive, painless, and can be done in the hospital or doctor’s office. The therapy can be turned off by Dr. Pallapothu at any time if you experiences any intolerable side effects.
Implanting a gastric stimulator has risks similar to any surgical procedure, including infection, discomfort, or bruising.
Most patients leave the hospital after 1 or 2 days. It is normal to have some pain at the neurostimulator site for 2 to 6 weeks after the surgery. Your doctor will help you manage any pain.
During your recovery, avoid heavy lifting and activities that involve excessive or repetitive bending, twisting, bouncing, or stretching. These movements could damage or displace your leads or affect the neurostimulator’s ability to provide stimulation.
You should not feel the stimulation. Call your doctor if symptoms return; they may indicate a problem with your implanted system.
Often, a combination of gastric electrical stimulation, diet modification, and medication is necessary to control symptoms of gastroparesis. Your gastroenterologist, endocrinologist, or primary care doctor will provide ongoing management of your condition and will prescribe any additional therapies you may need. You will receive a list of recommended diet and nutrition tips. Also, be sure to strictly follow any specialized diet your doctor has recommended for you.
Ratna Pallapothu, MD
Dr. Pallapothu has been performing this procedure in our area since 2010.
Dr. Pallapothu graduated from Guntur Medical College in Andhra Pradesh, India. He completed his residence at SUNY Buffalo School of Medicine in Buffalo, NY. Dr. Pallapothu is board certified in General Surgery. He was fellowship trained in Minimally Invasive Surgery/Advanced Laparoscopic & Bariatric Surgery at Baystate Medical Center in Springfield, MA where he was trained to perform gastric stimulator surgery.