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Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1.

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Presentation on theme: "Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1."— Presentation transcript:

1 Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1

2  Female  Type 1 diabetes has lead to peripheral neuropathy ◦ Resulted in gastroparesis  Peripheral neuropathy: In this case the patient has diabetic peripheral neuropathy in which the high blood sugar levels damaged her peripheral nerves ◦ Can cause pain (or sometimes lack of sensation) and loss of motor control

3  A stomach disorder in which a full thickness loss of cells of Cajal (neuroconducting cells of the stomach) leads to a decrease in gastric emptying  Stomach muscles function poorly ◦ Food digested slowly, results in a lot of pain  Common causes: ◦ Idiopathic in most cases ◦ Type 1 or 2 diabetes

4  Proper nutrition/diet changes: restrict fats, frequent but small meals, lots of fluids  Drugs: ◦ Prokinetic: improve rate of stomach emptying ex. Methylnaltrexone ◦ Antiemetic: control nausea and vomiting, no effect of stomach emptying ex. Prochlorperazine  Surgery: the last resort ◦ Pyroplasty: widening of pyloric valve ◦ Gastric ESTIM

5  Enterra neurostimulator implanted beneath the skin  Anode and cathode implanted in wall of stomach along the Greater Curvature  Handheld programming device is used to alter the degree and frequency of stimulation (catered to each patient)  Effectiveness has not been demonstrated

6 Patient PositionEquipment Used  Scissors  Marilyn dissector  O-suture  3-O silk R01 Suture  Debakey  Enterra neurostimulator  Two trochars (size 5)  One trochar (size 10)  Laparoscope  Hand held programming device to set frequency and degree of current discharge by the device

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8  Initial incisions: one midline incision between abdominal quadrants one and two for placement of scope  Two lateral incisions for size 5 trochars (5s are free) ◦ One in each abdominal quadrant

9  ID the pylorus  Deflate stomach  Mark point 10cm along Greater Curve of Stomach starting from pylorus  Insert leads into stomach wall ◦ Caudal lead at 9.5cm from pylorus ◦ Rostral lead at 10.5 cm from pylorus

10  Make pocket at Left mid- quadrant for subcutaneous placement of battery  Externalize leads  Close up  Interrogation: device that, when placed above ESTIM site, can be used to measure battery life and set the current released during each discharge of the device

11  Patient can be sent home that day  Possible complications: ◦ Pain, lack of healing, or infection where device was implanted ◦ Parts of device could wear through skin ◦ Allergic rxn to device ◦ Leads may perforate your stomach or device components may become entangled with or obstruct other internal organs ◦ Tissue damage from improper stimulation setting or malfunction

12  Gastric ESTIM is no longer being performed because the effectiveness of this procedure could not be demonstrated  Currently, ESTIM procedures are used for maladies such as: ◦ Xerostomia- dry mouth due to lack of saliva  Intraoral electrostimulation device increases salivary output of Parotid Gland ◦ Function electrical stimulation- use electrical stimulation to activate peripheral nerves affected by paralysis from spinal cord injury, head injury, stroke, etc  Sometimes referred to as neuromuscular electrical stimulation

13  Buckles, MD, Daniel, Jameson Forster, MD, and Richard McCallum, MD. "The Treatment of Gastroparesis in the Age of the Gastric Pacemaker: A Review." Medscape 5.4 (2003): 6. Web. 15 Apr  "About Gastroparesis." Medtronic. Medtronic Inc., Web. 15 Apr  McCallum, MD, Richard, William Snape, MD, Fredrick Brody, MD, and John Wo, MD. "Gastric Electrical Stimulation With Enterra Therapy Improves Symptoms From Diabetic Gastroparesis in a Prospective Study." Clinical Gastroenterology andHepatology 8.11 (2010): e1. Web. 15 Apr  Douglas, David. "Electrostimulation Relieves Xerostomia." Medscape News (2010): n. pag. Web. 15 Apr  Abell, MD, Thomas. "Gastric Electrical Stimulation for Medically Refractory Gastroparesis." University of California San Francisco. University of California San Francisco College of Medicine, Web. 15 Apr


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