Abstract
Purpose: Controversy over the significance of the Electrogastrogram (EGG) has continued to limit its clinical usefulness. We investigated the origins and significance of directly recorded EGG signals in response to physiologic maneuvers in patients with drug-refractory gastroparesis (GP). Methods: 10 female GP patients (mean age 43 years, GP etiology: 1 diabetic, 9 idiopathic) underwent permanent gastric electrical stimulation (GES) system implantation. Intraoperatively, after seromuscular electrode placement but prior to abdominal closure, EGG recordings were performed sequentially for at least five minutes during the following periods: stomach partial inflation during endoscopy (baseline = Base), endoscopic maximal insufflation (R1), desufflation (D1), re-insufflation (R2), and repeat desufflation (D2). EGG recordings were analyzed qualitatively for rhythm (regular = Reg Vs. irregular = Irreg) and amplitude (Equal or UnEqual) and quantitively for mean frequency (Freq, in CPM) and amplitude (Amp, in mV) as well as the Freq/Amp ratio (FAR). Results were compared for differences from baseline frequency (base to R1) and between R1 and R2 by paired t-tests. Results: After the initial Base period, the R2D2 maneuvers demonstrated more regularity and equal amplitude in the desufflation periods (D1 and D2). There was an initial decrease then stabilization in frequency (P= 0.002 for R1 from baseline and P= 0.04 between R1 and R2). In the insufflation and desufflation periods, a progressive decrease in amplitude was noted (P < 0.02 for R2 and D2 from baseline) and a gradual increase in the FAR were noted (P > 0.05) (see Table). Conclusion: Intraoperative serosal EGG recordings, when provoked by physiologic maneuvers, show reproducible characteristics in gastric electrical activity. EGG recordings of the relaxed stomach consistently display a more regular rhythm and equal amplitude than with the distended stomach. Maintenance of FAR both when relaxed and distended may be a measure of gastric homeostasis. Standardization of the EGG in terms of gastric distention may be needed for accurate physiologic interpretation.Table
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