Non-invasive thoracoabdominal mapping of post-oesophagectomy conduit function

Abstract

Introduction Oesophagectomy is a complex procedure performed for malignant and benign conditions. Post-oesophagectomy conduit dysfunction is common, which can occur for several reasons including conduit dysmotility. However, reliable tools for evaluating conduit motility are lacking. A non-invasive device for gastric electrical mapping was recently developed to evaluate gastric electrical activity and function. This study aimed to assess the feasibility of BSGM in the post-oesophagectomy stomach. Methods Oesophagectomy patients from Auckland, New Zealand, were recruited. The Gastric Alimetry System (New Zealand) was employed, comprising a stretchable array (8x8 electrodes), a wearable Reader, and validated iOS app for symptom logging. The protocol comprised a 30-minute baseline, a meal challenge, then 4 hours of post-prandial recordings. Analysis encompassed Principal Gastric Frequency, BMI-adjusted amplitude, Gastric Alimetry Rhythm Index (indicating rhythm stability), meal response, and symptoms. Adverse events were recorded. Results 6 patients were recruited and gastric activity was successfully captured in all except one with the colonic interposition (negative control). Four patients showed abnormalities indicating post-operative gastric hypofunction: four with low or abnormal frequency (<2.65 cycles/min), three with low amplitude (<22μV), two with low GA-RI (<0.25) and one with a reduced meal response. One patient had significant symptoms (nausea, early satiation) who demonstrated marked hypomotility in all four of these domains. No adverse events occurred. Conclusion Gastric Alimetry is a safe and feasible technique to non-invasively assess gastric conduit motility following oesophagectomy. Parameters may need adjustment for post-surgical anatomy. Clinical studies assessing the role in diagnosis and therapy can be advanced.

Meal Effects on Gastric Bioelectrical Activity Utilizing Body Surface Gastric Mapping in Healthy Subjects

“…The availability of a range of test meals is crucial for the wider application of BSGM tests in different clinical scenarios. While the original test meal with a large caloric challenge and mixed liquid/solid meal was selected in order to induce a gastric stressor that would provoke symptoms in diverse gastroduodenal populations 18,38 , smaller meals may be preferable in patients with lower tolerances, such as nausea and vomiting / gastroparesis patients 39 , post-surgical populations 14 , and perhaps paediatric populations in the future 40 . In a recent study using Gastric Alimetry in nausea and vomiting patients, for example, more than half of patients could not complete the full standard meal (median meal completion 90% (interquartile range 70-100)), although a sensitivity analysis did not show a change in primary outcome with reduced meal consumption 8 .…”

“…However, the optimal test meal for symptomatic individuals is uncertain, as some patients may have difficulty tolerating the relatively large meal 8 . In addition, smaller meals may be desirable to evaluate patients after gastric operations or in other contexts 14 .…”

Evaluation of gastric electrophysiology, symptoms and quality of life after pancreaticoduodenectomy

“…Recent advances in gastric mapping, including the high resolution intra-operative serosal mapping technique and the high-resolution non-invasive Gastric Alimetry system has led to significant improvements in the ability to quantify the electrophysiological changes of the stomach following surgery. Procedures such as sleeve gastrectomy, Billroth I reconstruction, and esophagectomies have all now been studied, with abnormal electrophysiology being identified in these cohorts (7, 10, 23). The Gastric Alimetry system not only employs a high-resolution array to accurately measure the gastric electrical activity, but also concurrently records the patients’ symptom evolution and defines associated objective phenotypes that may localise symptom origins within the GI tract, thereby enabling accurate correlation between symptoms and abnormal electrophysiology.…”

“…The copyright holder for this this version posted December 17, 2023. ; https://doi.org/10.1101/2023.12.14.23299984 doi: medRxiv preprint Gastric Alimetry® (Auckland, New Zealand) is a new non-invasive test to evaluate gastric electrophysiology and function at high resolution (HR), recently receiving regulatory approvals for clinical use (8). This technique has been extensively validated (5,7,9), and is being applied in medical disorders and more recently on esophagectomies, but has yet to be used for post-PD patients (10). This study aimed to assess the electrophysiology of the post-PD stomach using the Gastric Alimetry system, together with symptom evaluation and quality of life in post-PD patients.…”

Assessment of symptoms, quality of life and remnant gastric activity following gastric bypass using Gastric Alimetry®

“…It can be expected that a remnant stomach will become dormant and atrophic following the diversion of contents, however, the stomach likely also remains continuously bioelectrically and neurally active, which could be relevant to symptom (9, 10). Gastric dysrhythmias are of interest as they have been implicated in chronic nausea (11–13), as well as post-surgical symptoms after sleeve gastrectomy, esophagectomy, and partial gastrectomy (14–16), albeit exclusively in patients with stomachs still in continuity to date.…”