Gourcerol Guillaume, Chaput Ulriikka, LeBlanc Isabelle, Gallas Syrine, Michot Francis, Leroi Anne Marie, Ducrotte Philippe
Department of Physiology, Digestive Tract Research Group (ADEN EA 4311) and European Institute for Peptide Research (IFRMP23), Rouen University Hospital, University of Rouen, 1 Rue de Germont, 76031 Rouen cedex, France.
J Am Coll Surg. 2009 Aug;209(2):215-21. doi: 10.1016/j.jamcollsurg.2009.04.009. Epub 2009 Jun 18.
Gastric electrical stimulation (GES) represents a new therapy in patients with intractable vomiting and nausea. We aimed to determine preoperative factors associated with positive response during GES. Thirty-three consecutive patients received implants for medically refractory nausea or vomiting or both.
Symptoms, Quality of Life (QOL), and gastric emptying (GE) were monitored before and 6 months after implantation. Compared with baseline, dyspeptic symptoms including nausea and vomiting, and QOL all improved at 6 months, yielding a significant weight gain while the GE rate remained unchanged. Twenty-four patients reported improvement; nine remained unimproved at 6 months.
In multivariate analysis, baseline QOL and appetite alterations were predictive of improvement; previous history of gastric surgery was associated with failure. Surprisingly, patients with initial delayed GE (21 of 33) displayed similar improvement compared with patients with normal GE. Likewise, basal GE was not found to be predictive of positive outcomes, QOL, or symptoms improvement.
Patients with severe symptoms and altered QOL at inclusion particularly benefit from GES; delay in GE is not predictive of positive outcomes. This suggests that indication for GES should be based on clinical settings rather than initial GE, and then possibly extended to patients with normal GE.
胃电刺激（GES）是一种针对顽固性呕吐和恶心患者的新疗法。我们旨在确定与GES治疗期间阳性反应相关的术前因素。33例连续患者因药物难治性恶心或呕吐或两者皆有而接受植入治疗。
在植入前和植入后6个月监测症状、生活质量（QOL）以及胃排空（GE）情况。与基线相比，包括恶心和呕吐在内的消化不良症状以及生活质量在6个月时均有所改善，体重显著增加，而胃排空率保持不变。24例患者报告症状改善；9例在6个月时仍无改善。
在多变量分析中，基线生活质量和食欲改变可预测症状改善；既往胃手术史与治疗失败相关。令人惊讶的是，初始胃排空延迟的患者（33例中的21例）与胃排空正常的患者相比，改善情况相似。同样，未发现基础胃排空情况可预测阳性结果、生活质量或症状改善情况。
纳入研究时症状严重且生活质量改变的患者尤其能从胃电刺激中获益；胃排空延迟并不能预测阳性结果。这表明胃电刺激的适应症应基于临床情况而非初始胃排空情况，随后可能会扩展到胃排空正常的患者。
