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. 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

6. 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

7. Myoelectrical activity
Preprandial
Postprandial
200 µV
Direct signal
Power dB
Frequency
CPM
FFT
Position of EGG electrodes
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 4 EGG channel 1’ time period
Real time display
Period markers
Preprandial
Meal
Postprandial
RSA:
Running Spectrum Analysis
Motion Sensor Channel

16. Verify Fundus Corpus Antrum Pylorus Preprandial Meal Postprandial
Channel & Graph
selection display
Corpus
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 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

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