Safety and Feasibility of the Use of Transcutaneous Electrical Nerve Stimulation for Delayed Gastric Emptying after Pancreaticoduodenectomy: A Pilot Study

Authors

• Hannah Liefeld, Corewell Health West Resident
• Mathew Chung, Corewell Health West
• M Mura Assifi, Corewell Health West
• G Paul Wright, Corewell Health West
• Jason Aubrey, Corewell Health West Resident
• Mariam Khan, Corewell Health West Fellow
• Jesse Kelley, Corewell Health West Resident

Document Type

Conference Proceeding

Publication Date

2-2025

Abstract

INTRODUCTION: One of the most frequent complications after pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE), with an incidence quoted between 10-30%. Transcutaneous electrical nerve stimulation (TENS) initially emerged as a non-pharmacologic treatment for chronic pain; however, its application has reached beyond treating pain. We wanted to examine the safety and feasibility of TENS to reduce the incidence of DGE after PD.

METHODS: Patients who underwent PD between August 2023 to August 2024 at a single institution were recruited for the study prospectively. The primary aim was to investigate if TENS could be used safely in post-PD patients. Our secondary aim was to determine the rate of DGE in patients undergoing TENS treatment following PD. DGE was defined as the inability to return to standard diet by the first postoperative week or reinsertion of a nasogastric tube beyond postoperative day 3. A TENS 7000 device with two electrode pads was applied on both sides of the patient’s midline incision or on the patient’s mid-lower back. The TENS device was configured to setting 2 intensity level, 100 Hertz frequency and pulse width of 250 milliseconds for two, 30-minute treatments daily. Treatments were continued until postoperative day 7 or until discharge. Return of bowel function, resumption of a normal diet, adverse events and patient satisfaction were recorded.

RESULTS: Among the 29 patients who were recruited for the study, 20 patients (69%) completed the entirety of the treatment course. Six patients were excluded based on predefined criteria and three declined to participate in the study after PD. For the patients who completed the TENS treatment course, the average age at the time of surgery was 67.5 years with an average Charlson Comorbidity Index score of 5 points. There was a median return of bowel function on post-operative day 5 and an average length of stay of 7.35 days. Four (20%) patients experienced a complication unrelated to TENS usage. Two (10%) patients developed delayed gastric emptying despite TENS usage. One patient required reinsertion of a nasogastric tube beyond postoperative day 3 while the other patient was unable to return to a standard diet prior to postoperative day 7. Both patients eventually discharged home on a soft diet. No patient experienced TENS related complications or reported discomfort related to initiation of the device.

CONCLUSIONS: Our study confirms safe usage of the TENS device. A low rate of DGE (10%) was observed, however, more questions on ideal treatment parameters remain that warrant further study.

Comments

Advanced Cancer Therapies (ACT), February 14-17, 2025, Scottsdale, AZ

Recommended Citation

Liefeld H, Chung M, Assifi M, Wright GP, Aubrey JM, Khan M, et al. [Kelley J]. Safety and feasibility of the use of transcutaneous electrical nerve stimulation for delayed gastric emptying after pancreaticoduodenectomy: A pilot. American College of Surgeons Clinical Congress (ACS), 2025 Oct; Chicago, IL.