Abstract :Background: Treatment of drug-refractory gastroparesis (GP) may include gastric electrical
stimulation (GES) accompanied by Pyloroplasty. This approach has been shown to improve gastric
emptying and reduce symptoms up to 80%. One must be aware of the important although rare
complication of perforation of the gastric leads through the gastric mucosa into the lumen during
long-term follow up of the GES patients.
Case Report: Two recent cases represent the significant recurrence of symptoms in GP patients,
while interrogation of the GES system did not display abnormal readings of any parameters, with
special focus on potential changes of the impedance, representing resistance between the electrodes,
implanted 1 cm apart. Upon further evaluation via upper endoscopy, it was confirmed that there
was perforation of electrodes through the gastric mucosa into the gastric lumen in both patients
requiring surgical intervention to remove the electrodes and stimulator.
Conclusion: Impedance does not necessarily change to abnormal values when perforation of
electrodes through the gastric mucosa occurs in patients with GES devices, suggesting that
impedance may not serve as a predictor of luminal perforation. However, worsening symptom
control does seem to correlate with perforation of electrodes.