Shah Hamza, Wendorf Gregg, Ahmed Shifat, McElmurray Lindsay, Lahr Chris, Hughes Michael, Beauerle Brian, Miller Ed, Stocker Abigail, Abell Thomas L
Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S Jackson Street, ACB3 A3L15, Louisville, KY, 40202, USA.
University of Mississippi, Jackson, MS, USA.
Support Care Cancer. 2017 Jan;25(1):27-31. doi: 10.1007/s00520-016-3375-z. Epub 2016 Aug 17.
Malignancy-associated gastroparesis (MAG) is a cause of morbidity in cancer patients but therapies are lacking. Gastric electrical stimulation (GES) is a novel treatment for MAG. Here, we describe 19 patients with MAG who underwent temporary GES placement.
Nineteen patients (6 males, 13 females) with various malignancies were reviewed for symptom scores and physiologic measures at baseline and after temporary GES placement. Symptoms were scored by three variables: nausea (N), vomiting (V), and GI total symptom score (TSS). Physiologic profiles were measured by solid and liquid phase gastric emptying scans (GET) at 1, 2, and 4 h and cutaneous electrogastrogram (EGG) and mucosal electrogram (EG) frequencies. Symptoms were measured for 5 days after temporary endoscopic GES placement, and measures were repeated post GES placement.
Baseline GET results displayed delayed gastric emptying in 16 of 19 patients (mean solid retention 21.7 % at 4 h, normal <10 %; mean liquid retention 10.4 % at 4 h, normal <5 %). Cutaneous EGG (mean frequency 5.5 cpm) and EG (mean proximal frequency 5.1 cpm; mean distal frequency 5.1 cpm) showed evidence of neuromuscular dysfunction (normal 2.5-3.3 cpm). Symptom scores in N, V, and TSS showed statistically significant reduction after GES placement.
A small sample of patients with MAG and receiving temporary GES experienced symptom improvement, with less change on gastric emptying time or gastric electrical amplitude or frequency. GES may provide a potential therapeutic option for symptomatic management of MAG and evaluation of these MAG patients after permanent GES placement is ongoing. Prospective studies of MAG using temporary and permanent GES may be warranted.
恶性肿瘤相关性胃轻瘫（MAG）是癌症患者发病的一个原因，但缺乏有效的治疗方法。胃电刺激（GES）是一种针对MAG的新型治疗方法。在此，我们描述了19例接受临时性GES植入的MAG患者。
回顾性分析19例（6例男性，13例女性）患有各种恶性肿瘤的患者，记录其基线时以及临时性GES植入后的症状评分和生理指标。症状通过三个变量进行评分：恶心（N）、呕吐（V）和胃肠道总症状评分（TSS）。生理指标通过在1、2和4小时进行的固体和液相胃排空扫描（GET）、皮肤胃电图（EGG）以及黏膜电图（EG）频率进行测量。在临时性内镜下GES植入后对症状进行5天的测量，并在GES植入后重复测量各项指标。
基线GET结果显示，19例患者中有16例存在胃排空延迟（4小时时固体平均潴留率为21.7%，正常<10%；4小时时液体平均潴留率为10.4%，正常<5%）。皮肤EGG（平均频率5.5次/分钟）和EG（近端平均频率5.1次/分钟；远端平均频率5.1次/分钟）显示存在神经肌肉功能障碍的证据（正常为2.5 - 3.3次/分钟）。GES植入后，N、V和TSS的症状评分显示出统计学上的显著降低。
一小部分患有MAG并接受临时性GES治疗的患者症状得到改善，胃排空时间、胃电幅度或频率变化较小。GES可能为MAG的症状管理提供一种潜在的治疗选择，目前正在对这些MAG患者进行永久性GES植入后的评估。使用临时性和永久性GES对MAG进行前瞻性研究可能是必要的。
