Improvement of Esophageal Dysmotility with Transelectrical Stimulation (TES) in Lung Transplant Patients

Amaris, Manuel A.; Machuca, Tiago; Pipkin, M.; Nandavaram, Sravanthi; Daouk, Salim; Chandrashekaran, S.; Emtiazjoo, A.; Eagan, C.; Alnuaimat, Hassan; Peláez, Andrés

doi:10.1016/j.healun.2018.01.601

Cited by 2 publications

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“…Post-transplant, no acute rejection episodes occurred in the first year post transplant, and further no evidence of allograft dysfunction were present at the 4-year mark. We have reported our preliminary experience with TES applied between T6-T10 dermatomal levels (adrenergic autonomic control of distal esophagus and stomach) in esophageal motility 21 and gastric emptying in a small cohort of LTx patients. 22 In the pilot study presented here, we evaluated the acute effect of TES on the (i) contractile vigor of the esophagus, (ii) the upper esophageal sphincter resting pressure (UESP), (iii) the lower esophageal sphincter resting pressure (LESP), and the integrated relaxation pressure (IRP) in LTx patients.…”

Section: Introductionmentioning

confidence: 99%

“…Post‐transplant, no acute rejection episodes occurred in the first year post transplant, and further no evidence of allograft dysfunction were present at the 4‐year mark. We have reported our preliminary experience with TES applied between T6–T10 dermatomal levels (adrenergic autonomic control of distal esophagus and stomach) in esophageal motility 21 and gastric emptying in a small cohort of LTx patients 22 …”

Section: Introductionmentioning

confidence: 99%

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Acute transcutaneous electrical stimulation (TES) augments esophageal contractility in patients with weak peristalsis

Amaris

Atkinson

Machuca

et al. 2023

Clinical Transplantation

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Background: Lung transplantation (LTx) remains controversial in patients with absent peristalsis (AP) given the increased risk for gastroesophageal reflux (GER), and chronic lung allograft dysfunction. Furthermore, specific treatments to facilitate LTx in those with AP have not been widely described. Transcutaneous Electrical Stimulation (TES) has been reported to improve foregut contractility in LTx patients and therefore we hypothesize that TES may augment the esophageal motility of patients with ineffective esophageal motility (IEM). Methods:We included 49 patients, 14 with IEM, 5 with AP, and 30 with normal motility. All subjects underwent standard high-resolution manometry and intraluminal impedance (HRIM) with additional swallows as TES was delivered. Results: TES induced a universal impedance change observable in real-time by a characteristic spike activity. TES significantly augmented the contractile vigor of the esophagus measured by the distal contractile integral (DCI) in patients with IEM [median DCI (IQR) 0 (238) mmHg-cm-s off TES vs. 333 (858) mmHg-cm-s on TES; p = .01] and normal peristalsis [median DCI (IQR) 1545 (1840) mmHg-cm-s off TES vs. 2109 (2082) mmHg-cm-s on TES; p = .01]. Interestingly, TES induced measurable contractile activity (DCI > 100 mmHg-cm-s) in three out of five patients with AP [median DCI (IQR) 0 (0) mmHg-cm-s off TES vs. 0 (182) mmHg-cm-s on TES; p < .001]. Conclusion: TES acutely augmented contractile vigor in patients with normal and weak/ AP. The use of TES may positively impact LTx candidacy, and outcomes for patients with IEM/AP. Nevertheless, further studies are needed to determine the long-term effects of TES in this patient population. Sravanthi Nandavaram and Andres Pelaez contributed equally to this study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%