Novel application of GI electrical stimulation in Roux stasis syndrome (with video)

• Published in: Gastrointestinal endoscopy Vol. 74; no. 3; pp. 683 - 686
• Main Authors: Daram, Sumanth R., MD, Tang, Shou-Jiang, MD, Vick, Kenneth, MD, Aru, Giorgio, MD, Lahr, Christopher, MD, Amin, Om, MD, Taylor, Michelle, CFNP, Sheehan, John J., MD, Abell, Thomas L., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-09-2011; Elsevier
• Subjects: Abdominal Pain - etiology; Abdominal Pain - therapy; Anastomosis, Roux-en-Y - adverse effects; Biological and medical sciences; Digestive system. Abdomen; Electric Stimulation Therapy - methods; Endoscopy; Esophagus - surgery; Female; Gastrectomy - adverse effects; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Transit; Humans; Investigative techniques, diagnostic techniques (general aspects); Jejunostomy - adverse effects; Medical sciences; Middle Aged; Nausea - etiology; Nausea - therapy; Severity of Illness Index; Syndrome; Vomiting - etiology; Vomiting - therapy; GES; gastric electrical stimulation
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.05.023

Background About one-third of patients undergoing a Roux-en-Y anastomosis develop Roux stasis syndrome, likely because of disordered electrical conduction. GI electrical stimulation has been previously used successfully in the management of postsurgical gastroparesis. Objective Endoscopic placement of temporary electrodes and GI electrical stimulation in the management of severe Roux stasis syndrome in a patient with esophagojejunostomy and to determine whether the patient would be a candidate for surgical permanent electrode placement. Design Case report. Setting Academic medical center. Patients This study involved a patient with Roux stasis syndrome. Intervention Upper endoscopy was performed, followed by endoscopic placement of two temporary electrodes, one each in the two jejunal limbs. Electrical stimulation was provided by an external stimulation device. The patient was re-evaluated 5 days later. Main Outcome Measurements Electrogastrogram (EGG) parameters including frequency, amplitude, and frequency-amplitude ratio and total symptom score and health-related quality of life score. Results There was a significant improvement in EGG parameters with electrical stimulation. Also, the patient had a marked improvement in total GI symptom score, from 11 to 4, with a dramatic improvement in the health-related quality of life score from −3 to +3. Limitations Single case report. Conclusion Endoscopic placement of temporary electrodes is feasible and safe. GI electrical stimulation of the jejunal limb is a potentially effective treatment for Roux stasis syndrome.