E0690 - Physiological Impact of Spinal Cord Stimulation in Gastroparesis Patients With Chronic Abdominal Pain

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

JR

Jared Rejeski, MD

Wake Forest University School of Medicine
Winston-Salem, NC

Jared Rejeski, MD¹, Leonardo Kapural, MD, PhD², Kenneth Koch, MD¹
¹Wake Forest University School of Medicine, Winston-Salem, NC; ²Carolinas Pain Institute, Winston-Salem, NC

Introduction: Abdominal pain in patients with gastroparesis (GP) remains a major clinical problem. A study of GP patients with chronic, refractory abdominal pain who underwent high frequency spinal cord stimulation (SCS) therapy at the high-thoracic level reported improvements in nausea, vomiting, abdominal pain and satisfaction scores [1]. It is unclear if the stomach undergoes measurable changes in neuromuscular activity after SCS. AIMS: To determine the effects of long term SCS therapy on symptoms and gastric physiology in patients with GP.

Methods: An IRB approved, non-randomized, prospective cohort study was performed that included three patients (all women, ages 35-60) with idiopathic GP and chronic abdominal pain. GP was confirmed with solid phase 4 hour gastric emptying test (GET), and each had an electrogastrogram (EGG) with water load satiety test before SCS therapy. Patients were referred to the pain clinic for evaluation of refractory abdominal pain where they ultimately underwent SCS placement.

Results: Patients were recruited and returned an average of 38.3 months after SCS for follow up GCSI and PAGI-QOL surveys, EGG, and GET. Data were available from our prior registry studies on participant 1 and 2; participant 3 was unable to return for repeat GET. The table shows pre-SCS gastric dysrhythmias converted to normal 3 cpm rhythm in two of the three patients and water load volumes ingested improved in each patient at follow up. Delayed gastric emptying converted to normal in one patient and improved slightly in the second. PAGI-QOL scores improved in each patient.

Discussion: 1. Gastric dysrhythmias, water load volumes, and gastric emptying improved after SCS, indicating a potential physiologic basis for the clinical improvement reported in the larger observational studies with SCS implantation. 2. SCS is known to suppress sympathetic outflow via blockade of the superior hypogastric and/or celiac plexus providing a mechanistic basis for the physiologic changes seen in this study. 3. These observations support the rational for prospective studies of SCS in the large numbers of patients with gastroparesis and concomitant chronic abdominal pain.

	Pre-SCS	Post-SCS	Pre-SCS	Post-SCS	Pre-SCS	Post-SCS
	Participant 1		Participant 2		Participant 3
BMI	17	31	30	28	39	45
GCSI	n/a	3.78	n/a	0.89	n/a	3.22
PAGI-QOL	2.73	3.23	1.37	1.87	n/a	3.77
EGG WLT (cc)	150	200	275	700	250	600
EGG Rhythm	Mixed dysrhythmia	Normal	Bradygastria	Normal	Mixed dysrhythmia	Tachycgastria
GET 1hr	65	68	63	43	65	n/a
GET 4hr	25	20	22	2	18	n/a

Disclosures:

Jared Rejeski: Nevro Inc – Grant/Research Support.

Leonardo Kapural: Avanos – Grant/Research Support. Gimer – Advisory Committee/Board Member. Medtronics – Grant/Research Support. Neuralace – Grant/Research Support. Neuros – Grant/Research Support. Nevro – Grant/Research Support. PainTeq – Advisory Committee/Board Member. Presidio – Advisory Committee/Board Member. Xalud – Grant/Research Support.

Kenneth Koch indicated no relevant financial relationships.

Jared Rejeski, MD¹, Leonardo Kapural, MD, PhD², Kenneth Koch, MD¹. E0690 - Physiological Impact of Spinal Cord Stimulation in Gastroparesis Patients With Chronic Abdominal Pain, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.