PT - JOURNAL ARTICLE AU - Emma Paulon AU - Despoina Nastou AU - Francesca Jaboli AU - Juana Marin AU - Eric Liebler AU - Owen Epstein TI - Proof of concept: short-term non-invasive cervical vagus nerve stimulation in patients with drug-refractory gastroparesis AID - 10.1136/flgastro-2017-100809 DP - 2017 Oct 01 TA - Frontline Gastroenterology PG - 325--330 VI - 8 IP - 4 4099 - http://fg.bmj.com/content/8/4/325.short 4100 - http://fg.bmj.com/content/8/4/325.full SO - Frontline Gastroenterol2017 Oct 01; 8 AB - Background Gastric electric stimulation (GES) is a treatment approach to refractory gastroparesis, possibly acting centrally via afferent vagus nerve stimulation (VNS). Non-invasive VNS (nVNS) is a potential alternative to GES that could eliminate the safety risks of or identify likely responders to implantable neurostimulators.Objective This open-label proof-of-concept study assessed the effects of nVNS in patients with severe drug-refractory gastroparesis.Methods Patients used the Gastroparesis Cardinal Symptom Index (GCSI) to grade symptoms in diaries daily for 2 weeks before treatment (baseline) and during ≥3 weeks of nVNS therapy. Adverse events (AEs) were also diarised. Treatment was self-administered using an nVNS device (gammaCore, electroCore) and consisted of 120 s stimulations to the vagus nerve in the neck (two stimulations to each side three times daily during weeks 1 and 2; three stimulations to each side three times daily during week 3 and beyond). Response was defined as a ≥1 point decrease from baseline in GCSI score.Results Thirty-five patients enrolled; 23 were compliant with study procedures and were included in the analysis; 7 continued treatment beyond 3 weeks. Response rates were 35% (8/23) at 3 weeks and 43% (10/23) for the duration of therapy (3–6 weeks). For the entire cohort and the 10 responders, improvements from baseline were noted for mean total GCSI and GCSI subscale scores (nausea/vomiting, postprandial fullness/early satiety, bloating). No serious AEs were reported.Conclusions These preliminary results provide a signal that nVNS may be useful for treating refractory gastroparesis. Larger controlled studies are warranted.