The next reasonable step was to investigate the relationship of myoelectrical activity to gastric contractility in order to establish feasible parameters of electrical stimulation of the gastrointestinal tract in humans. Therefore, Keith Kelly, the distinguished Mayo Clinic surgeon is often recognized as the “Father of the clinical application of gastric pacing,” and deserves recognition and acknowledgment for his early initiatives towards electrical activities of the gut and his contributions to establishing a great interest in GI electrophysiology. Kelly and Laforce at Mayo Clinic induced anterograde and retrograde conduction of slow waves in canines with gastric stimulation in 1972. This body of work encouraged others to examine this innovative approach to control symptoms of dysmotility disorders. Only 18 papers were included as references, and all of them were crucial in building a foundation for the hypothesis to suggest a role for electrical stimulation in the GI tract. Searching the internet for the first published papers on electrical pacemakers utilized in gastroenterology uncovered the article published in 1963 when experimental development of gastrointestinal pacing was introduced for the first time as a promising therapeutic option for paralytic ileus. History and progression of the gastric electrical stimulation concept In addition, implementing nutritional support modalities, optimizing diabetic control, as well as improving lifestyle modifications are all required to maximize therapy. Unfortunately, the unpredictability of drug absorption in gastroparetics who also frequently vomit, poses further challenges. There is a need to consider new therapeutic options for the 30% or more of the gastroparetic population, whose symptoms are not addressed by existing drugs or investigational agents. The same medications with their sometimes severe side effects, as well as problems with tachyphylaxis, provide limited options for the growing number of gastroparetic patients around the world. The list of available prokinetic and antiemetic agents has changed very little in the last 30 years. In the clinical world of treating severe symptoms of drug-refractory gastroparesis, there are not many pharmacological or surgical options. GES in some patients improves gastric emptying, but its mechanism of action is not explained by improving gastric emptying or affecting the gastric electrical rhythm of gastroparetic patients, regardless of GP etiology. GES does not address, nor is it indicated for the reduction of abdominal pain or discomfort in gastroparetic (GP) patients. The most important effect of GES is its powerful antiemetic mechanism, which is beneficial when utilized as therapy for drug-refractory gastroparetic patients. The predominant mechanism of action of GES is by central control of nausea and vomiting by affecting the chemoreceptor trigger zone, and it also enhances vagal nerve function. Gastric electrical stimulation (GES) is a therapy providing neurostimulation via two electrodes implanted in the gastric smooth muscle.
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