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ID: 353 (Conflict of Interest: K)

Fünffache gastrointestinale Elektrostimulation mit EMG-basierter Motilitätsanalyse

J. F.Schiemer1, A.Heimann1, K.Somerlik-Fuchs2, L.Zimniak1, R.Ruff3, O.Kempski1, J.Baumgart1, H.Lang1, W.Kneist1
1Universitätsmedizin Mainz, Mainz
2Inomed Medizintechnik GmbH, Emmendingen
3Fraunhofer-Institut für Biomedizinische Technik (IBMT), St. Ingbert

Einleitung

Gastrointestinal motility disorders are poorly characterized but common and clinically significant conditions after multimodal oncologic therapy. Previous studies have shown feasibility and promising results of single spot gastrointestinal electrical stimulation. Only one human study performed dual device electrical stimulation of stomach and sacral nerves. The effects of several intestinal electrical stimulations on gastric tone were evaluated in a canine study. No previous study performed fivefold gastrointestinal electrical stimulation, including stomach (GES), duodenum (DES), jejunum (JES), ileum (IES) and colon (CES) with loco-regional electromyography-based motility analysis (EBMA) in a porcine model.

Material und Methoden

Four healthy male piétrain pigs with a mean body weight of 29 kg (range: 26- 33 kg) were studied after an overnight fast under general anesthesia. Four acute experiments were performed according to the guidelines of the local ethics committee. After laparotomy stomach, duodenum, jejunum, ileum and colon were successively exposed under preservation of innervation and blood supply. Monopolar hooked-wire and hook needle pair electrodes were subserosally applied. Every pair of electrodes was evaluated by impedance measurements. Neutral electrodes were placed in the abdominal wall. Baseline multi-channel EBMA was performed before stepwise GES, DES, JES, IES and CES. After electrical stimulation 3 min EBMA was completed. Electrical stimulation including four technical specifications was applied with a maximal amperage of 25 mA, a pulse width of 500 or 1000 µs, frequency range of 30 or 130 Hz and electrical stimulation time of 30 s.

Ergebnisse

Impedance measurements were in adequate range under 10 kΩ, giving indication of accurate positioning in the smooth muscle layer. EBMA was measurable in all four anaesthetized pigs in the stomach, duodenum, jejunum, ileum and colon. Recordings from implanted hooked-wire electrodes and hook electrodes showed rhythmic slow waves with fairly constant wave forms. More rapid frequencies were detectable as spike waves or spikes. EBMA revealed different spike frequencies in all five organs, representing organ-specific electrical activity. After GES, DES, JES, IES and CES significant changes in loco-regional electrical activity were assessable by multi-channel EBMA.

Schlussfolgerung

Progressive electrical stimulation of five parts of the gastrointestinal tract is feasible in a porcine model. EBMA is an appropriate technique for detection of stimulation-modulated gastrointestinal activity. Motility disorders of the gastrointestinal tract may be identified by multi-channel EBMA and governed by multi-spot electrical stimulation.