As a result, the efficacy of these agents in the treatment of gastroparesis is limited. Another option is surgical therapy of gastroparesis.14–16 Complete gastrectomy has been mainly employed to improve the symptoms in postsurgical gastroparesis (PSG).17,18 Therefore, gastroparesis brings continuing challenges

for PLX-4720 price physicians. In recent years, high-frequency gastric electrical stimulation (GES) has emerged as a new therapeutic modality for patients with refractory gastroparesis.19–22 High-frequency GES with the Enterra Therapy system (Medtronic, Minneapolis, MN, USA) has been approved for use under the Humanitarian Device Exemption by the US Food and Drug Administration for the treatment of Angiogenesis inhibitor gastroparesis of diabetic and idiopathic etiologies that are refractory to all medical management.23 The device produces intermittent bursts of high-frequency (∼14 cycles per second), short-duration pulses (∼330 µs) that are three to four times faster than the native gastric slow wave frequency. Recent studies have shown that high-frequency GES improves nausea and vomiting scores, health-related quality of life, hemoglobin A1C (HbA1c), and health-care costs.24–28 However, the effects on gastric emptying are not

uniform. The sample size of most treatment trials and clinical experiences are relatively small, although results are generally positive.29–53 Therefore, larger patient sample sizes would be preferred in order to obtain

a reliable result. Although O’Grady et al. indicated that this kind of GES, which is neurostimulation, can improve symptoms and gastric emptying,54 the sample size in the meta-analysis was small, and data in abstracts were also included, which might decrease the accuracy of the study. However, Zhang and Chen doubted that high-frequency GES improved MCE gastric emptying and could explain the improvement of symptoms.55 As a result, the relationship between the improvement of symptoms and gastric emptying is still a debated issue needing further research. It should also be noted that neither O’Grady et al. nor Zhang and Chen evaluated a detailed subgroup analysis of the main etiologies of gastroparesis patients, namely diabetes mellitus, idiopathic, and previous surgical procedures.56 Therefore, we are faced with discussion about whether the improvement of gastric emptying is associated with symptom improvement, and whether high-frequency GES has the same effect on the diabetic gastroparesis (DG), idiopathic gastroparesis (IG), and PSG subgroups. In order to address these problems, the primary purpose of this meta-analysis was to acquire more data about gastroparesis patients treated by high-frequency GES, while also taking into consideration that the quality of papers in the analysis would vary.