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) 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 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) Gastroparesis Functional Dyspepsisa Nausea & vomitting

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 Fundus Corpus Antrum Pylorus Pacemaker Duodenum

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. Fundus Corpus Antrum Pylorus Pacesetter Duodenum

Myoelectrical activity Preprandial Postprandial 200 µV Direct signal Power dB 5 10 Frequency CPM FFT Position of EGG electrodes In normal humans we see an increase in overall amplitude after a meal

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

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

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

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

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 & 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

Polygraf ID - POLYGRAM NET

Capture Mode On line RSA 4 EGG channel 1’ time period Real time display Period markers Preprandial Meal Postprandial RSA: Running Spectrum Analysis Motion Sensor Channel

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

Clinical View Normal Patient

Brady-Arrhythmia

Matrix View Normal Patient

Unique features (i) Integrated impedance check Multi-channel analysis 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

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

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

Enterra 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..

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

Thanks! FUNCTIONAL DIAGNOSTICS