functional diagnostics gastrointestinal electrogastrography (egg) the polygram net...
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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.
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Diseases (conditions)Diseases (conditions)
Gastroparesis
Functional Dyspepsisa
Nausea & vomitting
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Diseases (conditions)Diseases (conditions)
Gastroparesis (A slight degree of
gastroparalysis)
Functional Dyspepsia ( A range of
symptoms associated with food intake)
Nausea & vomiting
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Equipment & AccessoriesEquipment & Accessories
Polygraf ID® minimum 8 channels EGG main cable1, 3 or 4 ch. extension cableAg/AgCl electrodesSkin preparation gel & pasteMotion sensor & cable
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Polygraf ID - POLYGRAM NETPolygraf ID - POLYGRAM NET
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
VerifyVerifyVerifyVerifyPreprandial Meal Postprandial
Fundus
Corpus
Antrum
Pylorus
Channel & Graphselection display
Tools: cut,graph, Go to.
Add Event
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Clinical ViewClinical ViewClinical ViewClinical View
Normal Patient
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Brady-Arrhythmia
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Matrix ViewMatrix ViewMatrix ViewMatrix View
Normal Patient
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
CustomersCustomers
Mainstream gastroenterologists
Adult gastric emptying
specialist
Pediatric gastroenterologist
Antireflux surgeons
GI Physiologists
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
Enterra Therapy results..Enterra Therapy results..
FUNCTIONAL DIAGNOSTICSGASTROINTESTINAL
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 DIAGNOSTICSGASTROINTESTINAL
FUNCTIONAL DIAGNOSTICS
Thanks!Thanks!