Name of the Procedure:

Electronic Analysis of Implanted Neurostimulator Pulse Generator System (e.g., rate, pulse amplitude and duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance, and patient measurements) - Gastric Nerve Stimulation

Summary

This procedure involves using electronic equipment to analyze and optimize an implanted neurostimulator designed for gastric nerve stimulation. It entails assessing various parameters of the device, such as pulse rate, amplitude, battery status, and waveform configuration, to ensure it is functioning correctly and effectively managing symptoms.

Purpose

The procedure aims to ensure the implanted neurostimulator is working correctly to manage conditions affecting the gastric nerves, such as gastroparesis. The ultimate goal is to alleviate symptoms, improve patient comfort, and enhance the quality of life by adjusting the device settings to match the patient's needs.

Indications

• Chronic nausea
• Vomiting due to gastroparesis
• Poor control of gastric motility
• Refractory symptoms not managed by medication
• Patients with an implanted gastric neurostimulator

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Any necessary medication adjustments should be discussed with the healthcare provider.
• Previous diagnostic tests, such as imaging studies or gastric emptying tests, may be reviewed.

Procedure Description

1. The patient will be positioned comfortably, likely in a reclined chair or on a table.
2. The external programming device will be connected to the implanted neurostimulator wirelessly.
3. The healthcare professional will assess and record various device parameters, including pulse rate, amplitude, waveform configuration, and battery status.
4. Adjustments will be made based on the patient’s symptoms and feedback.
5. Electrode impedance and other measurements are taken to ensure proper functioning and placement of the device.
6. The patient's response to adjustments is monitored, and further tweaks are made as necessary.

Duration

The procedure typically takes 30 to 60 minutes.

Setting

The procedure is generally performed in an outpatient clinic, hospital, or specialized care center.

Personnel

• Neurologist or gastroenterologist specialized in neurostimulation
• Trained nurses or technician
• Potential involvement of an anesthesiologist if sedation is required

Risks and Complications

• Discomfort or mild pain during adjustments
• Rarely, infection at the site of the implanted device
• Device malfunction or failure
• Potential need for reprogramming if initial adjustments are not effective

Benefits

• Improved symptom control of nausea and vomiting
• Enhanced quality of life
• Non-pharmacological management of gastroparesis
• Immediate feedback on the effectiveness of adjustments

Recovery

• Typically, no recovery time is required.
• Patients can resume normal activities immediately.
• Follow-up appointments may be scheduled to monitor progress and make further adjustments.

Alternatives

• Pharmacologic treatments (e.g., anti-nausea medications)
• Dietary modifications
• Gastric electrical stimulation surgery
• Lifestyle changes
• Pros of alternatives: non-invasive, no surgery required.
• Cons of alternatives: may be less effective, longer time to see results.

Patient Experience

• Discomfort from adjustments might be felt but should be minimal.
• The procedure itself is generally well-tolerated.
• Pain management, if necessary, involves local anesthetics or mild sedatives.
• Immediate feedback from the adjustments helps quickly determine the optimal device settings.