Transcutaneous Electrical Stimulation Rescues Gastric Emptying in Lung Transplant Patients with Moderate to Severe Gastroparesis

Purpose Gastroparesis (GP) is prevalent after lung transplant (Ltx) (50-68%). GP has been associated with symptoms and delayed absorption of medications. Of particular concern after Ltx, GP can predispose to gastroesophageal reflux disease considered the main culprit for chronic allograft dysfunction. Therefore, early diagnosis and treatment is recommended in Ltx patients. Pharmacologic intervention for GP is not efficacious to improve gastric emptying and can induce potential serious side effects. Transcutaneous electric stimulation (TES) has been proposed to improve motility in various gastrointestinal motility disorders Methods We tested the hypothesis that TES may improve gastric emptying in Ltx patients. A 4-hour solid-phase gastric emptying study was done for worsening lung function before and after TES. Surveillance gastric emptying study (GEE) was done 2-12 weeks after TES. Five patients (4 female, age 48 ± 8), interval post-transplant (1-10 years), underwent TES as rescue therapy for moderate to severe GP (gastric retention >25% at 4 hours) that failed standard pharmacologic and dietary interventions. TES was delivered in continuous square wave, pulse rate 120 Hz, pulse width 220 µs, and pulse intensity to the maximum tolerated level without pain or muscle twitching. Two cutaneous electrodes were placed between T6 and T10 spinal levels (gastric autonomic segment) over the spine. Patients were instructed to use TES for 30 min after meals and for 30 min at bedtime Results Following TES, the percentage of gastric retention at 4 hours improved in the majority of patients (42 median, 25-73 min-max before TES; 20 median 7-43 min-max) after TES, p=0.01; figure 1). Three patients reported GP symptoms. Only one patient reported no significant improvement in the severity of symptoms Conclusion TES appears to modulate symptom perception and significantly improves gastric emptying in Ltx patients with moderate to severe gastroparesis