Temporary Gastric Stimulation in Patients With Gastroparesis Symptoms: Low-Resolution Mapping Multiple Versus Single Mucosal Lead Electrograms

Abstract

Background Cajal cells have a fundamental role in generating slow waves that regulate gastric motility. Gastric electrical stimulation (GES) is Food and Drug Administration (FDA)-approved for symptomatic treatment of drug refractory gastroparesis. We hypothesized that using two leads will vary from a single lead by providing greater insight of gastric electrical wave propagation, through differences in measured frequency, amplitude, and frequency over amplitude ratio. We also hypothesized that a significant reduction in symptomatic vomiting score is highly predictive in a single lead temporary gastric electrical stimulation. Methods A total of 111 patients with drug-refractory gastroparesis were enrolled. Forty-two patients had single lead, while 69 patients had two leads. All recordings measured mean frequency and amplitude in each lead. Patients documented symptoms using standardized symptom scores at baseline and day 5 post-procedure. Results Single lead patients with initial low mucosal frequency showed an increase from 3.10 to 4.93 (P = 0.0155), while the high frequency group decreased from 5.89 to 5.12 (P = 0.135). Vomiting score decreased significantly among both groups with GES (P = 0.0001). For two leads, the mucosal frequency decreased at the proximal electrode (P = 0.402), and increased at the distal electrode (P = 0.514), neither statistically significant (P = 0.143). Mucosal electrogram amplitude values changed for both proximal, mean decrease of 0.34 mV (P = 0.241), and distal, mean increase of 0.05 mV (P = 0.65) with a mean difference 0.34 mV (P = 0.238). However, mucosal electrogram frequency and amplitudes on day 5 were highly dependent on the baseline values (P < 0.001). Conclusions Compared to the use of single point electrodes, the use of two low-resolution electrodes allows recording gastric electrical wave propagation with greater detail. Low resolution recording appears to be superior to single point recordings, while awaiting practical high-resolution recordings.

Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity

“…Abnormalities in GMA may lead to gastric motility disorders, including abdominal pain, nausea, vomiting and early satiety (5,12,13). GMA only represent one component of control of gastric motility.…”

“…This condition was also seen in patients with atrophic gastritis and delayed gastric emptying. In one study (5), 111 patients with refractory gastroparesis who received gastric electrical stimulation were included. Two mucosal electrodes were placed simultaneously through endoscope in 69 patients and single mucosal electrode was placed in other 42 patients.…”

“…Compared with the single-point electrode, the two low-resolution electrodes could record gastric electrical transmission in more detail. The analysis of multi-electrode mucosal electrogastrograms is a useful method to understand the pathophysiology of gastroparesis (5). Although gastroelectric dysrhythmia often occurs in gastroparesis, the reliability of electrical diagnosis has always been controversial.…”

Domination of Gastric Complications Among Diabetic Patients

“…Low-energy shock wave can increase gastric contraction and emptying by activating axonal regeneration and increasing myenteric plexus, but not related with motility peptides [3,[36][37][38] . Gastric electrical stimulation (GES) (Enterra, Medtronics, Inc.) was approved by FDA in 2000 as a Humanitarian Use Device for patients with refractory diabetic or idiopathic GP [39][40][41] . On the other hand, high-frequency stimulation (HFS) has no effect on gastric emptying but is able to significantly reduce symptoms of nausea and vomiting in gastroparetic patients [42,43] .…”

Domination of Gastric Complications among Diabetic Patients

“…4,[37][38][39] Gastric Electrical Stimulation (GES) (Enterra, Medtronics, Inc.) was approved by US Food and Drug Administration (FDA) in 2000 as a Humanitarian Use Device for patients with refractory diabetic or idiopathic GP. [40][41][42] On the other hand, High-Frequency Stimulation (HFS) has no effect on gastric emptying but is able to significantly reduce symptoms of nausea and vomiting in gastroparesis patients. 43,44 Compared to the use of singlepoint electrodes, the use of two low-resolution electrodes allows recording gastric electrical wave propagation with greater detail.…”