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World J Gastroenterol. Jan 21, 2011; 17(3): 273-282
Published online Jan 21, 2011. doi: 10.3748/wjg.v17.i3.273
Gastric electrical stimulation for gastroparesis: A goal greatly pursued, but not yet attained
Mauro Bortolotti
Mauro Bortolotti, Department of Internal Medicine and Gastroenterology, University of Bologna, Via Massarenti 48, Bologna 40138, Italy
Author contributions: Bortolotti M solely contributed to this paper.
Correspondence to: Mauro Bortolotti, MD, Professor, Department of Internal Medicine and Gastroenterology, University of Bologna, Via Massarenti 48, Bologna 40138, Italy. bormau@tin.it
Telephone: +39-51-307901 Fax: +39-51-307901
Received: June 6, 2010
Revised: September 6, 2010
Accepted: September 13, 2010
Published online: January 21, 2011

The lack of an effective medical treatment for gastroparesis has pushed the research of new techniques of gastric electrical stimulation (GES) for nearly half a century of experimentation with a large variety of electrical stimuli delivered to the gastric wall of animals and patients with gastroparesis. Three principal methods are currently available: gastric low-frequency/high-energy GES with long pulse stimulation, high-frequency/low-energy GES with short pulse stimulation and neural sequential GES. The first method aims to reset a regular slow wave rhythm, but has variable effects on contractions and requires devices with large and heavy batteries unsuitable for implantation. High-frequency/low-energy GES, although inadequate to restore a normal gastric electro-mechanical activity, improves dyspeptic symptoms, such as nausea and vomiting, giving patients a better quality of life together with a more satisfactory nutritional status and is suitable for implantation. Unfortunately, the numerous clinical studies using this type of GES, with the exception of two, were not controlled and there is a need for definitive verification of the effectiveness of this technique to justify the cost and the risks of this procedure. The last method, which is neural sequential GES, consists of a microprocessor-controlled sequential activation of a series of annular electrodes along the distal two thirds of the stomach and is able to induce propagated contractions causing forceful emptying of the gastric content. The latter method is the most promising, but has been used only in animals and needs to be tested in patients with gastroparesis before it is regarded as a solution for this disease.

Keywords: Gastric electrical stimulation, Gastric emptying, Gastric motility, Gastric myoelectric activity, Gastroparesis, Prokinetic drugs