Gastric electrical stimulation medical policy manual. Gastric electrical stimulation ges or gastric pacing for any other indication is. Pdf gastric electrical stimulation for gastroparesis. Gastric electrical stimulation prestige health choice. Clinical policy gastric electrical stimulation page 2 of 6 discomfort. Gastric electrical stimulation is considered investigational for the treatment of gastroparesis of diabetic, idiopathic, or postsurgical etiology. All patients undergoing ges from october 2003 to july 2007. Gastric electrical stimulation is performed using an implantable device designed to treat chronic drugrefractory nausea and vomiting secondary to gastroparesis of diabetic, idiopathic or postsurgical etiology. Gastric electrical stimulation ges, also referred to as gastric pacing, using an implantable device, has been investigated primarily as a treatment for gastroparesis. Please note that this is a type of electrical stimulation that is considered a benefit exclusion in many health plan contracts.
Gastric electrical stimulation international neuromodulation society. Gastric electrical stimulation ges delivers electrical stimuli to the musculature of the gastric wall by means of electrodes which are connected to a stimulator device. Please refer to the state medicaid manual for any coverage provisions. Gastric electrical stimulation offers a new alternative for the treatment of drugrefractory gastroparesis. Gastric electrical stimulation for refractory gastroparesis. Gastric electrical stimulation page 2 of 6 background gastric electrical stimulation for gastroparesis gastroparesis is a disorder in which there is delayed gastric emptying following ingestion of food, in. Temporary percutaneous gastric electrical stimulation. Medical therapy in the form of diet and pharmacotherapy has limited effect on weight. Hasler division of gastroenterology, university of michigan health system, ann arbor, mi, usa abstract development of gastric electrical stimulation techniques for treatment of gastric.
Corporate medical policy gastric electrical stimulation. Recently, a number of studies on electrical stimulation of the stomach in both humans and dogs have indicated that gastric electrical stimulation with appropriate parameters is able to entrain. Gastric electrical stimulation is an effective and safe. Role of gastric electrical stimulation in the treatment of. Gastric electrical stimulation, also known as implantable gastric stimulation, is the use of specific devices to provide electrical stimulation to the stomach to try to bring about weight loss in those who are overweight or improve gastroparesis gastric electrical stimulation is a pacemakerlike device with electrical. Pdf computer model of gastric electrical stimulation. Gastric electrical stimulation is considered investigational for the treatment of gastroparesis of diabetic or idiopathic etiology. Gastric electrical stimulation health quality ontario.
Diaphragmaticphrenic nerve stimulation electric stimulation for pain, swelling and function in a clinical setting extracorporeal shock wave therapy eswt for musculoskeletal conditions and soft tissue wounds gastric pacing gastric electrical stimulation. Recently, gastric electrical stimulation ges has been inves tigated as a new. Gastric electrical stimulation for chronic symptomatic gastroparesis. According to the manufacturer, the enterra therapy system is composed of a neurostimulator, an implantable intramuscular lead and an external programming system. Gastric electrical stimulation ges is performed using an implantable device designed to treat chronic drugrefractory nausea and vomiting secondary to gastroparesis of diabetic, idiopathic, or postsurgical. Gastric electrical stimulation has also been investigated as a treatment of obesity. Gastric electrical stimulation is considered investigational for the treatment of obesity. A small, batterypowered gastric neurostimulator is implanted beneath the skin in the lower abdominal region. Currently, only one gastric electrical stimulator has received approval from the u. A novel technique tested in patients with nonestablished indications for ges. Gastric electrical stimulation about the therapy medtronic. Standard bariatric surgery is effective but is associated with morbidity and mortality, creating an unmet need for alternative therapies.
The system uses the implanted neurostimulator to deliver electrical impulses to nerves in the stomach. Gastric electrical stimulation has been proposed for use in patients with gastroparesis who are refractory to medical treatment. Nausea and vomiting may be so severe that they cause weight loss, dehydration, electrolyte disturbances, and malnutrition. When policy topic is not covered gastric electrical stimulation is considered investigational for the treatment of. The aim of the study was to simulate gastric electrical stimulation using a computer model of gastric electrical activity and suggest a possible avenue toward reliable gastric pacing. This study analyzes a cohort of gastroparetic patients after ges. Medical coverage policy gastric electrical stimulation. Gastric electrical stimulation corporate medical policy. Health technology assessment series are freely available in pdf format at the. Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and longterm followup. Objectiveto investigate the longterm efficacy of highfrequency gastric electrical stimulation ges for treating diabetic gastroparesis research design and. Gastric electrical stimulation ges is performed using an implantable. Gastroparesis is a longterm chronic illness where the stomach. Methods of gastric electrical stimulation and pacing.
Gastric electrical stimulation is considered investigational for the. Gastric electrical stimulation ontario health technology. Gastric pacing with a gastric pacemaker involves the use of a set of pacing wires attached to the stomach and an external electrical device that provides a lowfrequency, highenergy stimulation. Recently, gastric electrical stimulation ges has been used to treat gastroparesis. Gastric electrical stimulation for obesity springerlink. The american college of gastroenterology conditionally recommends gastric electrical stimulation for compassionate treatment in patients with refractory symptoms of gastroparesis, particularly nausea and vomiting. Currently available devices consist of a pulse generator, which can be programmed to provide electrical stimulation at different frequencies, connected to intramuscular. Limitations four months of gastric electrical stimulation did not accelerate gastric emptying or increase of quality of life. Gastric electrical stimulation ges is performed using an implantable device designed to treat chronic drugrefractory nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology. Modifying stomach contractions through gastric electrical stimulation ges the equivalent of a gut pacemaker holds potential for treating not only gastric motor. Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis daniel mckenna, md, agretchen beverstein, apnp, mark reichelderfer, md,b eric gaumnitz, md,b and. Gastric electrical stimulation ges is performed using an implantable device designed to treat chronic drugrefractory nausea and vomiting secondary to gastroparesis of diabetic, idiopathic, or postsurgical etiology. Obesity is a growing health problem worldwide with a major impact on health and healthcare expenditures. Recommended doctors for gastroparesis diagnosis management the following physicians were recommended by others with gastroparesis.
Page 2 of 5 an independent licensee of the blue cross and blue shield association gastric electrical stimulation benefits application this medical policy relates only to the services or supplies described. It has been hypothesized that electrical stimulation of the gastric musculature could result in paced, coordinated gastric. Medical policy gastric electrical stimulation effective. One such therapy, the application of electrical stimulation. There have been conflicting results from trials of gastric electrical stimulation ges for treatment of refractory vomiting, associated or not with gastroparesis. The american college of gastroenterology conditionally recommends gastric electrical stimulation for compassionate treatment in patients with refractory symptoms of gastroparesis, particularly nausea.
Gastric electrical stimulation with the medtronic enterra tm system helps control the chronic nausea and vomiting associated with gastroparesis by stimulating the smooth muscles of the lower stomach. Gastric electrical stimulation ges is a low morbidity treatment that may be effective in patients who are refractory to medical therapy. Temporary percutaneous gastric electrical stimulation ges. Food and drug administration fda see note below, the gastric electrical. A recommendation is graded conditional when there is uncertainty about the desirable effects of an intervention. Gastric electrical stimulation further investigation is needed to confirm the effectiveness of gastric stimulation in long term blinded fashion, which patients are likely to respond, the optimal electrode position, and the optimal stimulation.
Gastric electrical stimulation ges is a treatment that sends weak electrical. Gastric electrical stimulation is performed using an implantable device designed to treat chronic drugrefractory nausea and vomiting secondary to gastroparesis of diabetic, idiopathic, or postsurgical etiology. Treatment of diabetic gastroparesis by highfrequency. Gastric electrical stimulation has been proposed as a surgical alternative for treating gastroparesis that remains refractory to medical management and for treating obesity in adults who have not achieved. Gastric electrical stimulation reduces refractory vomiting. Gastric electrical stimulation with enterra therapy improves. Gastroelectrical stimulation ges is a relatively new treatment option for individuals. Electrical stimulation of the gastric musculature has been introduced as an alternative to drugs or surgery for treatment of patients with gastroparesis abrahamsson et al.
Gastric electrical stimulation ges gastric electrical st imulat on ges h asbeen d ev l ped an alternat ive trea ment for refr c ory gastr par esis. Medical policy gastric electrical stimulation ges guidelines this policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. This implanted device delivers highfrequency electrical stimulation at four. Temporary gastric electrical stimulation ges is considered experimental, investigational or unproven. Gastric electrical stimulation further investigation is needed to confirm the effectiveness of gastric stimulation in long term blinded fashion, which patients are likely to respond, the optimal electrode position, and the optimal stimulation parameters, none of which have been rigorously evaluated to date. Surgery details enterra therapy also known as gastric electrical stimulation, or ges involves what is more appropriately labeled as a gastric. When policy topic is not covered gastric electrical stimulation. Presented herein is a case report of a laparoscopic gastric electrical stimulator implantation for drugrefractory gastroparesis. Gastric electric stimulation for the treatment of chronic. Evidence supporting use of ges and the pathophysiology of. Gastric electrical stimulation ges has been used in patients who are proven refractory. The device may be referred to as a gastric pacemaker. Gastric electrical stimulation ges also referred to as gastric pacing, using an implantable device, has been investigated primarily as a treatment for gastroparesis. Gastric electrical stimulation is a procedure in which a surgically implanted device sends out brief, lowenergy impulses to your stomach to help against nausea and vomiting.