Endocrine Abstracts

Introduction: The management of diabetic gastroparesis resistant to medical therapy is very difficult – the most severely affected patients often spend many days as hospital inpatients with intractable nausea and vomiting and consequent dehydration, leading to a marked reduction in quality of life. Recently, gastric pacing (also known as gastric electrical stimulation (GES)) has been tried in these patients as a means of correcting the physiological deficit. It has shown promise in some international trials although patient numbers are still quite small. It has seen use in four patients in Ireland. Here we outline our experiences with these patients.

Methods: The records of all four patients with gastric pacemakers inserted were reviewed. The number of days spent as an inpatient by each patient before and after pacemaker insertion was calculated. From these figures, a cost benefit analysis was performed to see if the commencement of GES led to a reduction in the costs incurred due to inpatient admission for gastroparesis. The costs were calculated using 2004 bed day costs for Cork University Hospital from the Irish Health Service Executive (costings department).

Results: The bed cost for the inpatient stays of all four patients in the twelve months preceding pacemaker insertion was &z.euro;306,399. The corresponding extrapolated figure for the year following pacemaker insertion was &z.euro;322,543. There was no HbA1c change following GES.

Conclusion: Severe diabetic gastroparesis leads to recurrent patient admissions and places a large cost burden on the Irish healthcare system. However, the cost benefits of GES are as yet unproven in Ireland. There is very little data available worldwide which convincingly shows a cost benefit with GES, although some studies have shown a subjective improvement in patients’ symptoms. Therefore, more research is needed on this contentious area.