Procedure helps identify patients who may benefit from permanent implantation

The first temporary endoscopic neurostimulator implantation in the region was performed recently at Jewish Hospital, part of KentuckyOne Health. For patients with severe gastroparesis, a disorder that slows or stops the movement of food from the stomach to the small intestine, this procedure can determine if a permanent implant will restore their ability to digest.

The temporary implant was followed by placement of a permanent device, which stimulates the nerves and muscles in the stomach to aid digestion in a manner similar to how a pacemaker is used to control heart rhythm.

During the procedure, stimulating electrodes are fixed to the muscle of the antrum (lower stomach). The connector end of each lead is attached to the neurostimulator, which is then placed in a small pocket through an incision in the abdomen.

The stimulation triggers the muscles to move food through the stomach as it would during normal digestion, alleviating symptoms and helping patients get back to a more normal way of life.

For patients with severe gastroparesis, this procedure can significantly improve their quality of life. Due to the condition, many patients are unable to eat full meals. In severe cases, it may have been several years since a patient’s last meal.

Gastroparesis can occur in patients who have undergone a transplant, gastric bypass surgery or small bowel resection and in patients who are diabetic. Symptoms include chronic nausea and vomiting.

The temporary endoscopic procedure was performed by Thomas Abell, M.D., Director of the Jewish Hospital GI Motility Clinic and the Arthur M. Schoen, M.D. chair in Gastroenterology at the University of Louisville, who specializes in gastric motility, the movements of the stomach that aid in digestion by moving food into the small intestine. The permanent device was placed by Robert Cacchione, M.D., associate professor of Surgery at UofL. Cacchione has extensive experience with gastric stimulation devices.

“The addition of a clinical trial of temporary stimulation can help select patients who may benefit from an implantable (device) before they undergo a permanent surgical placement,” said Abell. “We’re glad for the support of Jewish Hospital and University of Louisville to allow this new approach to be used here in Louisville.”

The patient who received the first temporary implantation was Christie Woodruff, a 54- year-old nurse practitioner from Gainsville, Ga. Woodruff has been unable to eat normally for more than six years, using an IV as her main source of nutrition. Over the course of her illness, she lost over 100 pounds.

Woodruff saw doctors at top medical facilities throughout the midwest and southeast, but found her options limited. When she found Dr. Abell, she said she didn’t want to get her hopes up, but just days after her procedure, she was experiencing a renewed quality of life.

“I’ve been fortunate to already see a 60-70 percent improvement since the surgery,” said Woodruff. “It will take a while to fully adjust, but I look forward to getting back to normal life with my husband, enjoying life as empty nesters, working out together again and regaining the muscle I lost.”

Abell pioneered the development of the implantable neurostimulator with medical device manufacturer Medtronic while at the University of Tennessee. His research includes conducting National Institutes of Health-sponsored clinical trials to standardize the treatment protocols for gastroparesis while at the University of Mississippi. One such trial is now under way at the University of Louisville.

Gastric electrical stimulation was developed nearly 25 years ago for use in patients with the signs of gastroparesis, such as primarily vomiting, nausea and pain, who did not respond to other treatments. The use of gastric electrical stimulation has increased since its approval by the FDA in March of 2000.