The prevalence of obesity is growing to epidemic proportions,and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss.Behavior and lifestyle therapy ar...The prevalence of obesity is growing to epidemic proportions,and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss.Behavior and lifestyle therapy are safe treatments for obesity in the short term,but the durability of the weight loss is limited.Although promising obesity drugs are in development,the currently available drugs lack efficacy or have unacceptable side effects.Surgery leads to long-term weight loss,but it is associated with morbidity and mortality.Gastric electrical stimulation(GES) has received increasing attention as a potential tool for treating obesity and gastrointestinal dysmotility disorders.GES is a promising,minimally invasive,safe,and effective method for treating obesity.External gastric pacing is aimed at alteration of the motility of the gastrointestinal tract in a way that will alter absorption due to alteration of transit time.In addition,data from animal models and preliminary data from human trials suggest a role for the gut-brain axis in the mechanism of GES.This may involve alteration of secretion of hormones associated with hunger or satiety.Patient selection for gastric stimulation therapy seems to be an important determinant of the treatment's outcome.Here,we review the current status,potential mechanisms of action,and possible future applications of gastric stimulation for obesity.展开更多
AIM： To investigate the effect of two-channel gastric electrical stimulation （GES） with trains of pulses on gastric emptying and slow waves.METHODS： Seven dogs implanted with four pairs of electrodes and equipped ...AIM： To investigate the effect of two-channel gastric electrical stimulation （GES） with trains of pulses on gastric emptying and slow waves.METHODS： Seven dogs implanted with four pairs of electrodes and equipped with a duodenal cannula were involved in this study. Two experiments were performed.The first experiment included a series of sessions in the fasting state with trains of short or long pulses, each lasted 10 min. A 5-min recording without pacing was made between two sessions. The second experiment was performed in three sessions （control, single-channel GES, and two-channel GES）. The stimulus was applied via the 1st pair of electrodes for single-channel GES （GES via one pair of electrodes located at 14 cm above the pylorus）, and simultaneously via the 1st and 3rd channels for two-channel GES （GES via two pairs of electrodes located at 6 and 14 cm above the pylorus）, Gastric liquid emptying was collected every 15 min via the cannula for 90 min.RESULTS： GES with trains of pulses at a pulse width of 4 ms or higher was able to entrain gastric slow waves. Two-channel GES was about 50% more efficient than single-channel GES in entraining gastric slow waves. Two-channel but not single-channel GES with trains of pulses was capable of accelerating gastric emptying in healthy dogs. Compared with the control session, two-channel GES significantly increased gastric emptying of liquids at 15 rain （79.0% ± 6.4% vs 61.3% ± 6.1%, P 〈 0.01）, 30 min （83.2% ± 6.3 % vs 68.2% ± 6.9%, P 〈 0.01）, 60 min （86.9% ± 5.5 % vs 74.1% ± 5.9%, P 〈 0.01）, and 90 rain （91.0% ± 3.4% vs 76.5% ± 5.9%, P 〈 0.01）.CONCLUSION： Two-channel GES with trains of pulses accelerates gastric emptying in healthy dogs and may have a therapeutic potential for the treatment of gastric motility disorders.展开更多
AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric ele...AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.展开更多
文摘The prevalence of obesity is growing to epidemic proportions,and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss.Behavior and lifestyle therapy are safe treatments for obesity in the short term,but the durability of the weight loss is limited.Although promising obesity drugs are in development,the currently available drugs lack efficacy or have unacceptable side effects.Surgery leads to long-term weight loss,but it is associated with morbidity and mortality.Gastric electrical stimulation(GES) has received increasing attention as a potential tool for treating obesity and gastrointestinal dysmotility disorders.GES is a promising,minimally invasive,safe,and effective method for treating obesity.External gastric pacing is aimed at alteration of the motility of the gastrointestinal tract in a way that will alter absorption due to alteration of transit time.In addition,data from animal models and preliminary data from human trials suggest a role for the gut-brain axis in the mechanism of GES.This may involve alteration of secretion of hormones associated with hunger or satiety.Patient selection for gastric stimulation therapy seems to be an important determinant of the treatment's outcome.Here,we review the current status,potential mechanisms of action,and possible future applications of gastric stimulation for obesity.
基金Supported by Funds from Union Hospital and University of Texas Medical Branch
文摘AIM： To investigate the effect of two-channel gastric electrical stimulation （GES） with trains of pulses on gastric emptying and slow waves.METHODS： Seven dogs implanted with four pairs of electrodes and equipped with a duodenal cannula were involved in this study. Two experiments were performed.The first experiment included a series of sessions in the fasting state with trains of short or long pulses, each lasted 10 min. A 5-min recording without pacing was made between two sessions. The second experiment was performed in three sessions （control, single-channel GES, and two-channel GES）. The stimulus was applied via the 1st pair of electrodes for single-channel GES （GES via one pair of electrodes located at 14 cm above the pylorus）, and simultaneously via the 1st and 3rd channels for two-channel GES （GES via two pairs of electrodes located at 6 and 14 cm above the pylorus）, Gastric liquid emptying was collected every 15 min via the cannula for 90 min.RESULTS： GES with trains of pulses at a pulse width of 4 ms or higher was able to entrain gastric slow waves. Two-channel GES was about 50% more efficient than single-channel GES in entraining gastric slow waves. Two-channel but not single-channel GES with trains of pulses was capable of accelerating gastric emptying in healthy dogs. Compared with the control session, two-channel GES significantly increased gastric emptying of liquids at 15 rain （79.0% ± 6.4% vs 61.3% ± 6.1%, P 〈 0.01）, 30 min （83.2% ± 6.3 % vs 68.2% ± 6.9%, P 〈 0.01）, 60 min （86.9% ± 5.5 % vs 74.1% ± 5.9%, P 〈 0.01）, and 90 rain （91.0% ± 3.4% vs 76.5% ± 5.9%, P 〈 0.01）.CONCLUSION： Two-channel GES with trains of pulses accelerates gastric emptying in healthy dogs and may have a therapeutic potential for the treatment of gastric motility disorders.
文摘AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.
