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

FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL

Electrogastrography (EGG)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)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


Objective of EGG testsObjective 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


Diseases (conditions)Diseases (conditions)

Gastroparesis

Functional Dyspepsisa

Nausea & vomitting


Major Regions of the StomachMajor Regions of the Stomach

Fundus

Corpus

Antrum

Pylorus

Pacemaker

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


ElectrogastrographyElectrogastrography

Fundus

Corpus

Antrum

Pylorus

Pacesetter

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


Myoelectrical activityMyoelectrical activity

Position of EGG electrodes

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

Preprandial

Postprandial

200

µV

Direct signal

Po

wer

dB

5 10 Frequency CPM

FFT

Po

wer

dB

5 10 Frequency CPM


Diseases (conditions)Diseases (conditions)

Gastroparesis (A slight degree of

gastroparalysis)

Functional Dyspepsia ( A range of

symptoms associated with food intake)

Nausea & vomiting


Clinical applicationsClinical 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


EGG multi-channel analysisEGG 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


Improved diagnostic confidenceImproved 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


Spectrum analysis graph ( EGG)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


Equipment & AccessoriesEquipment & Accessories

Polygraf ID® minimum 8 channels EGG main cable1, 3 or 4 ch. extension cableAg/AgCl electrodesSkin preparation gel & pasteMotion sensor & cable


Polygraf ID - POLYGRAM NETPolygraf ID - POLYGRAM NET


Capture ModeCapture ModeCapture ModeCapture Mode

On line RSA

1’ time period

4 EGG channel

Real time display

Motion Sensor ChannelRSA: Running Spectrum Analysis

PreprandialMeal

Postprandial

Period markers


VerifyVerifyVerifyVerifyPreprandial Meal Postprandial

Fundus

Corpus

Antrum

Pylorus

Channel & Graphselection display

Tools: cut,graph, Go to.

Add Event


Clinical ViewClinical ViewClinical ViewClinical View

Normal Patient


Brady-Arrhythmia


Matrix ViewMatrix ViewMatrix ViewMatrix View

Normal Patient


Unique features (i)Unique features (i)

Integrated impedance checkTests 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 reportPOLYGRAM NET software platform

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

of recorded data


Unique features (ii)Unique features (ii)

Symptom diary

Windows 2000™ operating system

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


CustomersCustomers

Mainstream gastroenterologists

Adult gastric emptying

specialist

Pediatric gastroenterologist

Antireflux surgeons

GI Physiologists


Enterra therapyEnterra therapy

Implantable pacemaker for the stomach

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


Enterra Therapy results..Enterra Therapy results..


CompetitorsCompetitors

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


FUNCTIONAL DIAGNOSTICS

Thanks!Thanks!

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

Documents

vomiting slide

event slide

frequency cpm slide

duodenum duodenum slide

prokinetics q

place q

myoelectrical etiology

prokenetic agent slide