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Electrogastrography (EGG) PowerPoint PPT Presentation


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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. Electrogastrography (EGG).

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Electrogastrography (EGG)

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Electrogastrography egg l.jpg

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.


Electrogastrography egg2 l.jpg

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


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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


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Diseases (conditions)

  • Gastroparesis

  • Functional Dyspepsisa

  • Nausea & vomitting


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Pacemaker

Fundus

Corpus

Pylorus

Antrum

Major Regions of the Stomach

  • The Fundus, provides a reservoir for food allowing it to be accomodated without an excessive increase in intragastric pressure

  • The Corpus, where the enzyme pepsin is produced. The gastric pacemaker is located at the great curvature of the corpus.

  • The Antrum, where the hormone Gastrin is produced and where mixing and grinding of the food takes place

  • The Pylorus,is the valve between the stomach and the duodenum. It helps controling the emptying of the stomach contents into the duodenum

Duodenum


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Pacesetter

Fundus

Corpus

Pylorus

Antrum

Electrogastrography

  • The normal EGG activity is around 3 cpm

  • The 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


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FFT

Direct signal

Preprandial

Power dB

Power dB

200 µV

Postprandial

5 10 Frequency

CPM

5 10 Frequency

CPM

Position of EGG electrodes

Myoelectrical activity

In normal humans we see an increase in overall amplitude after a meal


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Diseases (conditions)

  • Gastroparesis (A slight degree of gastroparalysis)

  • Functional Dyspepsia ( A range of symptoms associated with food intake)

  • Nausea & vomiting


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Clinical applications

  • Non-ulcer functional dyspepsia detected by gastric dysrhythmia

  • Gastroparesis detected by a drop in EGG peakpower and/or post-prandial decreased activity in 3 cpm range

  • Monitor efficacy of prokinectic agents

  • Assess the risk of post-operative retching and complications in laparotomy Nissen Fundoplication


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EGG multi-channel analysis

  • Why perform a multi-channel analysis ?

  • Detect whether the pacemaker’s 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


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Improved diagnostic confidence

  • EGG can select those patients who will respond to prokinetics

  • 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


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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


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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


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Polygraf ID - POLYGRAM NET


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Capture Mode

On line RSA

1’ time period

4 EGG channel

Real time display

Period markers

Preprandial

Meal

Postprandial

RSA:

Running Spectrum Analysis

Motion Sensor Channel


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Verify

Preprandial

Postprandial

Meal

Fundus

Corpus

Channel & Graph

selection display

Tools: cut,

graph, Go to.

Add Event

Antrum

Pylorus


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Clinical View

Normal Patient


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Brady-Arrhythmia


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Matrix View

Normal Patient


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Unique features (i)

  • Integrated impedance check

    • Tests impedance in less than 5 sec.

    • Step by step on screen guide (skin preparation and electrode placement)

  • Multi-channel analysis

  • Ease of use

    • No calibration

    • Clinical protocol and report

    • POLYGRAM NET software platform

  • State of the art analysis algorithms by Dr.Chen facilitates short term and long term analyses of recorded data


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Unique features (ii)

  • Symptom diary

  • Windows 2000™ operating system

  • Real-time on-screen Running Spectrum Analysis during capture facilitates easy artifact detection and removal


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Customers

  • Mainstream gastroenterologists

  • Adult gastric emptying specialist

  • Pediatric gastroenterologist

  • Antireflux surgeons

  • GI Physiologists


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Enterra therapy

  • Implantable pacemaker for the stomach

  • A treatment of chronic nausea and vomiting associated with gastroparesis when conventional drug therapies are not effective


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Enterra Therapy results..


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Competitors

  • 3CPM

    • Currently most prominent competitor - distribution via Sandhill

    • Old system, chunky technology, DOS based, EGG only

  • MMS

    • Up to seven channels

    • FFT analysis, DOS based


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Thanks!

FUNCTIONAL DIAGNOSTICS


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