Electroceutical Approaches for Gastroparesis

Paskaranandavadivel, Niranchan; Avci, Recep; Nagahawatte, Nipuni D; Farajidavar, Aydin; Cheng, Leo K.

doi:10.1007/978-3-030-53370-0_72

Cited by 9 publications

(7 citation statements)

References 94 publications

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“…The degradation of ICC numbers and network integrity are associated with disordered slow wave and motility patterns (see section "High Resolution Slow Wave Mapping"). Therefore, a variety of electrical therapies have been proposed to treat gastroparesis (Paskaranandavadivel et al, 2020). Therapies have reported to both improve symptoms (McCallum et al, 2010(McCallum et al, , 2013Ducrotte et al, 2020), and in some cases improve gastric emptying rates (McCallum et al, 1998) (see section "Gastric Stimulation and Pacing" for further details).…”

Section: Gastroparesismentioning

confidence: 99%

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Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

et al. 2021

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Gastric pacing and stimulation strategies were first proposed in the 1960s to treat motility disorders. However, there has been relatively limited clinical translation of these techniques. Experimental investigations have been critical in advancing our understanding of the control mechanisms that innervate gut function. In this review, we will discuss the use of pacing to modulate the rhythmic slow wave conduction patterns generated by interstitial cells of Cajal in the gastric musculature. In addition, the use of gastric high-frequency stimulation methods that target nerves in the stomach to either inhibit or enhance stomach function will be discussed. Pacing and stimulation protocols to modulate gastric activity, effective parameters and limitations in the existing studies are summarized. Mathematical models are useful to understand complex and dynamic systems. A review of existing mathematical models and techniques that aim to help refine pacing and stimulation protocols are provided. Finally, some future directions and challenges that should be investigated are discussed.

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Section: Gastroparesismentioning

confidence: 99%

“…Significant research has also been devoted to the application of electrical stimuli to modulate gastric function. However, gaps remain in our knowledge and clinical acceptance remains limited (Yin and Chen, 2008;Paskaranandavadivel et al, 2020).…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

et al. 2021

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“…The small intestine is the longest segment of the gastrointestinal (GI) tract and has the primary role of absorbing nutrients through coordinated movement of chyme across the intestine. Studies have shown the presence of co‐regulatory mechanisms of motility, primarily involving the neuro‐muscular and enteric nervous systems functioning in tandem to modulate motility 1–3 . In particular, rhythmic pacesetter bio‐potentials, named slow waves, play a key role in governing intestinal motility and are generated and propagated by the interstitial cells of Cajal (ICC) 4–6 .…”

Section: Introductionmentioning

confidence: 99%

“…14 Electroceuticals are an emerging therapy that involves the application of extrinsic pulses at different frequencies to modulate the intrinsic bio-potentials of the gut. 1 High-frequency stimulation applies low-energy short pulses at a frequency higher than approximately 1 Hz, whereas low-frequency pacing involves the application of highenergy long pulses at a frequency closer to the intrinsic slow-wave frequency. In healthy humans, the intrinsic slow-wave frequency of the stomach is approximately 3 cycles per minute (cpm).…”

Section: Introductionmentioning

confidence: 99%

“…Gastric pacing has successfully entrained slow‐wave electrical activity and has reported success in enhancing and inhibiting the gastric emptying rates 23–25 . Initial results have highlighted potential opportunities for investigations targeted at the treatment of gastric dysmotility, including gastroparesis and obesity 1,26 . While significant pacing research has been conducted in gastric modulation on both humans and animals, 27,28 the efficacy of small intestine pacing as a potential therapy is yet to be established.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of small intestine pacing parameters for modulation of gut function

Nagahawatte

Cheng

Avci

et al. 2022

Neurogastroenterology Motil

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Background and Purpose:The efficacy of conventional treatments for severe and chronic functional motility disorders remains limited. High-energy pacing is a promising alternative therapy for patients that fail conventional treatment. Pacing primarily regulates gut motility by modulating rhythmic bio-electrical events called slow waves.While the efficacy of this technique has been widely investigated on the stomach, its application in the small intestine is less developed. This systematic review was undertaken to summarize the status of small intestinal pacing and evaluate its efficacy in modulating bowel function through preclinical research studies. Methods:The literature was searched using Scopus, PubMed, Ovid, Cochrane, CINAHL, and Google Scholar. Studies investigating electrophysiological, motility, and/or nutrient absorption responses to pacing were included. A critical review of all included studies was conducted comparing study outcomes against experimental protocols. Results:The inclusion criteria were met by 34 publications. A range of pacing parameters including amplitude, pulse width, pacing direction, and its application to broad regional small intestinal segments were identified and assessed. Out of the 34 studies surveyed, 20/23 studies successfully achieved slow-wave entrainment, 9/11 studies enhanced nutrient absorption and 21/27 studies modulated motility with pacing. Conclusion:Small intestine pacing shows therapeutic potential in treating disorders such as short bowel syndrome and obesity. This systematic review proposes standardized protocols to maximize research outcomes and thereby translate to human studies for clinical validation. The use of novel techniques such as high-resolution electrical, manometric, and optical mapping in future studies will enable a mechanistic understanding of pacing.

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Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

Nagahawatte,

Avci,

Paskaranandavadivel

et al. 2024

Sci Rep

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Pacing has been proposed as a therapy to restore function in motility disorders associated with electrical dysrhythmias. The spatial response of bioelectrical activity in the small intestine to pacing is poorly understood due to a lack of high-resolution investigations. This study systematically varied pacing parameters to determine the optimal settings for the spatial entrainment of slow wave activity in the jejunum. An electrode array was developed to allow simultaneous pacing and high-resolution mapping of the small intestine. Pacing parameters including pulse-width (50, 100 ms), pulse-amplitude (2, 4, 8 mA) and pacing electrode orientation (antegrade, retrograde, circumferential) were systematically varied and applied to the jejunum (n = 15 pigs). Pulse-amplitudes of 4 mA (p = 0.012) and 8 mA (p = 0.002) were more effective than 2 mA in achieving spatial entrainment while pulse-widths of 50 ms and 100 ms had comparable effects (p = 0.125). A pulse-width of 100 ms and a pulse-amplitude of 4 mA were determined to be most effective for slow wave entrainment when paced in the antegrade or circumferential direction with a success rate of greater than 75%. These settings can be applied in chronic studies to evaluate the long-term efficacy of pacing, a critical aspect in determining its therapeutic potential.

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Electroceutical Approaches for Gastroparesis

Cited by 9 publications

References 94 publications

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches

Systematic review of small intestine pacing parameters for modulation of gut function

Optimization of pacing parameters to entrain slow wave activity in the pig jejunum

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