Andersson S, Lönroth H, Simrén M, Ringström G, Elfvin A, Abrahamsson H
Departments of Internal Medicine and Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Neurogastroenterol Motil. 2006 Sep;18(9):823-30. doi: 10.1111/j.1365-2982.2006.00801.x.
Gastric electrical stimulation (GES) is effective for medically refractory nausea and vomiting in patients with idiopathic or diabetic gastroparesis (DGP). We studied whether GES has similar effects in chronic intestinal pseudoobstruction (CIP). Patients referred for chronic small bowel (SB) motor dysfunction requiring parenteral nutrition and having a weekly vomiting frequency (WVF) >/=7 refractory to prokinetics and antiemetics were included. Patients were implanted for high-frequency GES 12 stimuli min(-1), laparoscopy being the first-line implantation procedure. Results were compared with those obtained in 11 DGP patients. Three patients with familial CIP and one patient with postsurgical CIP fulfilled the criteria. Gastric emptying was delayed in two and was normal in two patients. SB transit time was markedly delayed. Laparoscopy was used in three patients, one patient required laparotomy. During GES, WVF decreased from 24 (mean) before GES to 6.9 at 12 months and 7.5 at last visit. Vomiting reduction was 50-90% at last visit. For the DGP patients, WVF decreased from 23 before GES to 3.5 at 12 months and 3.5 (P < 0.01) at last visit. In patients with CIP and medically refractory vomiting, GES seems to have an anti-vomiting effect comparable to that seen in patients with severe DGP. GES should be considered as a therapeutic option for these patients.
胃电刺激（GES）对特发性或糖尿病性胃轻瘫（DGP）患者的药物难治性恶心和呕吐有效。我们研究了GES在慢性假性肠梗阻（CIP）中是否有类似作用。纳入因慢性小肠（SB）运动功能障碍需要肠外营养且每周呕吐频率（WVF）≥7次、对促动力药和止吐药难治的患者。患者接受高频GES植入（12次刺激/分钟），腹腔镜检查为一线植入方法。将结果与11例DGP患者的结果进行比较。3例家族性CIP患者和1例术后CIP患者符合标准。2例患者胃排空延迟，2例正常。SB转运时间明显延迟。3例患者采用腹腔镜检查，1例患者需要开腹手术。在GES治疗期间，WVF从GES前的平均24次降至12个月时的6.9次和末次随访时的7.5次。末次随访时呕吐减少50% - 90%。对于DGP患者，WVF从GES前的23次降至12个月时的3.5次和末次随访时的3.5次（P < 0.01）。在CIP和药物难治性呕吐患者中，GES似乎具有与严重DGP患者相当的止吐作用。GES应被视为这些患者的一种治疗选择。
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