Electrogastrography (EGG)

1. 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.

2. 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

3. 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

4. Diseases (conditions) • Gastroparesis • Functional Dyspepsisa • Nausea & vomitting

5. 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

6. 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

7. 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

8. Diseases (conditions) • Gastroparesis (A slight degree of gastroparalysis) • Functional Dyspepsia ( A range of symptoms associated with food intake) • Nausea & vomiting

9. Clinical applications • Non-ulcer functional dyspepsia detected by gastric dysrhythmia • Gastroparesis detected by a drop in EGG peak power 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

10. 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

11. 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

12. 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

13. 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

14. Polygraf ID - POLYGRAM NET

15. 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

16. Verify Preprandial Postprandial Meal Fundus Corpus Channel & Graph selection display Tools: cut, graph, Go to. Add Event Antrum Pylorus

17. Clinical View Normal Patient

18. Brady-Arrhythmia

19. Matrix View Normal Patient

20. 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

21. Unique features (ii) • Symptom diary • Windows 2000™ operating system • Real-time on-screen Running Spectrum Analysis during capture facilitates easy artifact detection and removal

22. Customers • Mainstream gastroenterologists • Adult gastric emptying specialist • Pediatric gastroenterologist • Antireflux surgeons • GI Physiologists

23. Enterra therapy • Implantable pacemaker for the stomach • A treatment of chronic nausea and vomiting associated with gastroparesis when conventional drug therapies are not effective

24. Enterra Therapy results..

25. 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

26. Thanks! FUNCTIONAL DIAGNOSTICS