Enterra Therapy Program: Surgery Details
Enterra ™ Therapy (also known as Gastric Electrical Stimulation, or GES) involves what is more appropriately labeled as a gastric neurostimulator, although it is commonly referred to as a "pacemaker."
It is often called a "pacemaker" because it looks similar to the cardiac pacemakers that are used to help patients with electrical disturbances in their heart. The electrical energy delivered to the stomach during Enterra ™ Therapy is high frequency and low amplitude; generally not sufficient to make the stomach contract or even empty better in many cases. What Enterra ™ Therapy often does do is:
- Improve symptoms of gastroparesis
- Improve patient's quality of life
- Improve nutrition in patients who are malnourished as a result of their gastroparesis
- Improve glycemic control in Diabetics with gastroparesis
Enterra ™ Therapy is not a cure for gastroparesis, but it may help significantly with the symptoms that result from the condition. The effect varies from person to person and results are not guaranteed.
What are the risks of the surgery?
Enterra ™ Therapy is generally a very safe procedure. The procedure is entirely reversible and the generator and leads can be removed at any time if necessary.
Some of the risks include infection (which may require removal of the device), erosion of the generator through the skin, perforation or erosion of the leads through the stomach wall, bleeding, injury to the internal organs, blockage of the intestines, a blood clot in the legs or lungs, or a heart attack. There are also risks of general anesthesia. As with any other surgical procedure, there are additional risks that your surgeon and the surgeon's team will discuss with you in person prior to surgery.
Will I feel the electrical stimulation?
Most patients do not feel the electrical stimulation.
Can other people see the neurostimulator?
The generator is about 2 ½ inches by 2 inches by ½ inch thick. It is positioned deep under the skin on your abdomen, but not inside of your abdominal cavity. When you are wearing a shirt, the device is usually not apparent to other people.
How long does the neurostimulator battery last?
The battery life is about 5-10 years. When the battery in the device wears out, you will need to have the generator replaced with a minor surgical procedure. What kinds of activities and/or treatments should I avoid after the neurostimulator has been implanted?
- Patients should avoid activities that put undue stress on the implanted devices. Activities that include sudden, excessive, repetitive bending, twisting, bouncing, or stretching can cause the lead to break or dislodgement of the devices.
- Patients should avoid rubbing or twisting the device on purpose. Patients should not dive below 33 feet of water, or enter hyperbaric (decompression) chambers.
- Diathermy is a form of heat energy. Diathermy is often used in surgical procedures (electrocautery) and in certain colonoscopic or endoscopic procedures (polypectomy or treatment of bleeding). Patients with an implanted gastric neurostimulator CANNOT have any shortwave diathermy, microwave diathermy, or therapeutic ultrasonic diathermy (also known as deep heat treatment) anywhere on their body. These kinds of diathermy can permanently damage the neurostimulator and may cause you injury as well.
- Patients with an implanted gastric neurostimulator cannot have MRI's.
- The neurostimulator may interfere with other implanted devices such as an implanted defibrillator or pacemaker.
- Be careful when approaching theft detector and security screening devices (such as those found in airports, libraries, and some department stores). If possible, go around the device. Show the security personnel your patient identification card and ask for a manual (by hand) search. If you have to go through a theft detector or screening device, approach the center of the device and walk through normally. Do not linger or lean against the screening device.
- Pregnancy: Safety for use during pregnancy or delivery has not been established. It is possible that the side effects could be dangerous for an unborn child. It is important that women of childbearing potential use some type of birth control during this therapy. If you find that you are pregnant, you must inform your doctor as soon as possible to discuss your options.
UW Research Publications
UW Researchers examined the safety and effectives of GES. For interested patients, their paper is included here:
- Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis (pdf)