Post written by Gregg Wendorf, MD, from the University of Louisville, Louisville, Kentucky.

Our case highlights a patient undergoing permanent gastric electrical stimulator (GES) placement. Part of this surgical procedure involves the surgeon attaching electrical leads from the GES to serosa of the stomach and inserting to the muscularis propria. Several adverse events related to this lead placement may arise. These include lead migration, lead perforation, pocket site infection, and bleeding. Endoscopy is performed intraoperatively to evaluate the site of gastric lead placement from within the lumen for perforation of the leads. Should the leads be seen endoscopically, they must be removed and reattached and then examined again to ensure no further perforation. This may decrease the risk of serious adverse events in the post-operative course.

Patients with gastroparesis will often have clinically significant malnutrition, which can affect wound healing and their ability to fight infection. As such, these patients are at higher risk for post-operative adverse events such as infection and poor wound healing than might be a well-nourished patient. For this reason, we felt it important to highlight how an intraoperative endoscopy may decrease the risk of these adverse events by ensuring the gastric leads have not perforated the gastric body, which is a risk factor for significant post-operative morbidity and mortality.

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