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FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Electrogastrography (EGG) The POLYGRAM NET ElectroGastroGraphy Application is intended to record, store, view and.

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Presentation on theme: "FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Electrogastrography (EGG) The POLYGRAM NET ElectroGastroGraphy Application is intended to record, store, view and."— Presentation transcript:

1 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Electrogastrography (EGG) The POLYGRAM NET ElectroGastroGraphy Application is intended to record, store, view and analyze gastric myoelectrical activity as an aid in the diagnosis of gastrointestinal motility disorders.

2 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Electrogastrography (EGG) EGG is a non-invasive technique that permits prolonged and repeated recordings of gastric electrical activity EGG detects abnormal myoelectrical rhythms, providing an easy way to define motor pathophysiology; it helps doctors to stratify patients and improve confidence in their therapheutic recommendations

3 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Objective of EGG tests To access whether and to what degree electrical dysrhytmia of the stomach exist in those patients with symptoms suggestive of a gastric motor abnormality. These symptoms include early satiety after a meal, bloating, epigastric pain, nausea and vomiting

4 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Diseases (conditions) q Gastroparesis q Functional Dyspepsisa q Nausea & vomitting

5 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Major Regions of the Stomach Fundus Corpus Antrum Pylorus Pacemaker q The Fundus, provides a reservoir for food allowing it to be accomodated without an excessive increase in intragastric pressure q The Corpus, where the enzyme pepsin is produced. The gastric pacemaker is located at the great curvature of the corpus. q The Antrum, where the hormone Gastrin is produced and where mixing and grinding of the food takes place q The Pylorus, is the valve between the stomach and the duodenum. It helps controling the emptying of the stomach contents into the duodenum Duodenum

6 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Electrogastrography Fundus Corpus Antrum Pylorus Pacesetter qThe normal EGG activity is around 3 cpm qThe gastric pacesetter generates an electrical signal every 20 sec, that travels towards the antrum, and in response to a caloric challenge or drug, creates powerful peristaltic contractions that force antral contents towards the pylorus and assist in grinding and mixing food. Duodenum

7 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Myoelectrical activity Position of EGG electrodes In normal humans we see an increase in overall amplitude after a meal Preprandial Postprandial 200 µV Direct signal Power dB 5 10 Frequency CPM FFT Power dB 5 10 Frequency CPM

8 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Diseases (conditions) q Gastroparesis (A slight degree of gastroparalysis) q Functional Dyspepsia ( A range of symptoms associated with food intake) q Nausea & vomiting

9 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Clinical applications q Non-ulcer functional dyspepsia detected by gastric dysrhythmia q Gastroparesis detected by a drop in EGG peak power and/or post-prandial decreased activity in 3 cpm range q Monitor efficacy of prokinectic agents q Assess the risk of post-operative retching and complications in laparotomy Nissen Fundoplication

10 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL EGG multi-channel analysis Why perform a multi-channel analysis ? Detect whether the pacemakers frequency remains constant (coupled) or becomes uncoupled as it propagates down the stomach. Detect whether the power of the signal increases as it migrates to the antrum - suggesting normal contractility in the stomach after a meal or a prokenetic agent

11 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Improved diagnostic confidence q EGG can select those patients who will respond to prokinetics q In combination with gastric emptying scintigraphy test - which gives motor activity results- we can confirm or exclude a gastric motor abnormality and identify or exclude a myoelectrical etiology

12 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Spectrum analysis graph ( EGG) Healthy patient: Increased signal power/amplitude postprandially Gastroparesis: No increased signal in response to a solid meal. The dominant frequency postprandially is abnormal: tachy- and/or bradygastria / dysrythmia

13 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Equipment & Accessories Polygraf ID ® minimum 8 channels EGG main cable 1, 3 or 4 ch. extension cable Ag/AgCl electrodes Skin preparation gel & paste Motion sensor & cable

14 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Polygraf ID - POLYGRAM NET

15 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Capture Mode On line RSA 1 time period 4 EGG channel Real time display Motion Sensor Channel RSA: Running Spectrum Analysis Preprandial Meal Postprandial Period markers

16 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL VerifyVerify Preprandial Meal Postprandial Fundus Corpus Antrum Pylorus Channel & Graph selection display Tools: cut, graph, Go to. Add Event

17 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Clinical View Normal Patient

18 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Brady-Arrhythmia

19 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Matrix View Normal Patient

20 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Unique features (i) q Integrated impedance check Tests impedance in less than 5 sec. Step by step on screen guide (skin preparation and electrode placement) q Multi-channel analysis q Ease of use No calibration Clinical protocol and report POLYGRAM NET software platform q State of the art analysis algorithms by Dr.Chen facilitates short term and long term analyses of recorded data

21 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Unique features (ii) q Symptom diary q Windows 2000 operating system q Real-time on-screen Running Spectrum Analysis during capture facilitates easy artifact detection and removal

22 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Customers q Mainstream gastroenterologists q Adult gastric emptying specialist q Pediatric gastroenterologist q Antireflux surgeons q GI Physiologists

23 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Enterra therapy q Implantable pacemaker for the stomach A treatment of chronic nausea and vomiting associated with gastroparesis when conventional drug therapies are not effective

24 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Enterra Therapy results..

25 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL Competitors q 3CPM l Currently most prominent competitor - distribution via Sandhill l Old system, chunky technology, DOS based, EGG only q MMS l Up to seven channels l FFT analysis, DOS based

26 FUNCTIONAL DIAGNOSTICS GASTROINTESTINAL FUNCTIONAL DIAGNOSTICS Thanks!


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