TOPLINE:

Combining pyloroplasty with gastric electrical stimulation (GES) in patients with refractory gastroparesis leads to greater symptom improvement than pyloroplasty alone. When GES is used later in the pyloroplasty-only group, their symptoms improve to levels comparable to those in the combined group.

METHODOLOGY:

• GES is approved for treating chronic nausea and vomiting when pharmacologic therapy fails; although pairing GES with pyloroplasty has shown promise, the combination has not been tested in a double-blind, randomized clinical trial.
• Researchers randomly assigned patients with diabetic or idiopathic gastroparesis who did not respond to medical therapy to receive pyloroplasty either with or without GES.
• In the combined group, GES was activated immediately after surgery, whereas in the pyloroplasty-only group, the GES device remained off for 3 months and was then activated for the subsequent 3 months.
• Primary outcomes were the Gastroparesis Cardinal Symptom Index (GCSI) and total symptom score; other outcomes included gastric emptying and length of hospital stay.
• Outcomes were assessed at baseline and at 3- and 6-month follow-up visits.

TAKEAWAY:

• Of the 38 patients included (mean age, 46.7 years; 36.8% male), 81.6% had diabetic gastroparesis and 18.4% had idiopathic gastroparesis.
• At 3 months, the combined group demonstrated significantly greater improvements in GCSI (median difference, -1.33; P = .01) and total symptom score (median difference, -12.00; P = .005) than the pyloroplasty-only group.
• Both groups showed significant and similar improvements in gastric emptying retention at 3 months compared with baseline.
• When GES was activated at 3 months in the pyloroplasty-only group, gastroparesis symptoms improved significantly by 6 months, indicating that delayed activation provided additional benefit beyond pyloroplasty alone.
• The pyloroplasty-only group also experienced a significant reduction in median hospital length of stay, from 4.1 days at baseline to 0 days at 6 months, with an excellent safety profile.

IN PRACTICE:

“GES increases symptomatic relief, and while immediate activation leads to earlier maximal benefit, delayed activation of GES after [pyloroplasty] can achieve equivalent symptomatic control,” the authors of the study wrote.

SOURCE:

The study was led by Irene Sarosiek, MD, Division of Gastroenterology, Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas. It was published online on December 9, 2025, in JAMA Network Open.

LIMITATIONS:

The study included a small sample of patients with idiopathic gastroparesis, limiting subgroup analysis. There were no data on antiemetic use, and longer follow-up is needed to assess long-term effects. Variations in surgical techniques, GES programming, dietary protocols, and surgeon experience may limit generalizability.

DISCLOSURES:

The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.