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Han X, Zhu H. Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity. Front Surg 2023; 9:1035723. [PMID: 36684308 PMCID: PMC9852521 DOI: 10.3389/fsurg.2022.1035723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
With the gradual deepening of the study of gastric motility disorders, people increasingly realize that gastric myoelectric activity plays an important role in coordinating gastric function. This article introduces the advantages of endoscopic mucosal electrodes compared with traditional electrodes. Several different types of mucosal electrodes and how to fix the electrodes by endoscope are introduced. Endoscopic mucosal electrodes can record and regulate gastric myoelectric activity, which has great value in the study of gastric motility. Endoscopic mucosal electrode technique refers to the fixation of the electrode in the designated part of the gastric mucosa by endoscope. Through endoscopic mucosal electrodes, on the one hand, we can record gastric myoelectric activity, on the other hand, we can carry out gastric electrical stimulation to interfere with gastric rhythm. Endoscopic mucosal electrodes have higher accuracy than traditional cutaneous electrodes, less trauma and lower cost than serosal electrodes. Endoscopic mucosal electrodes have a good application prospect for diseases such as gastroparesis and obesity.
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O'Grady G, Gharibans A, Calder S, Andrews C. Retrograde slow-wave activation: a missing link in gastric dysfunction? Neurogastroenterol Motil 2021; 33:e14112. [PMID: 33644950 DOI: 10.1111/nmo.14112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Stefan Calder
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Chris Andrews
- Department of Gastroenterology, University of Calgary, Calgary, Canada
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Percutaneous Electrical Neurostimulation (PENS) of Dermatome T6 with an Ambulatory Self-applied Patch vs PENS of Dermatome T6 with Conventional Procedure: Effect on Appetite and Weight Loss in Moderately Obese Patients. Obes Surg 2016; 26:2899-2905. [DOI: 10.1007/s11695-016-2214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen S, Li Y, Yao S, Zhang Y, Liu L, Guo X, Chen W, Chen Y, Du Y. Implantable Colonic Electrical Stimulation Improves Gastrointestinal Transit and Defecation in a Canine Constipation Model. Neuromodulation 2015; 19:108-15. [PMID: 26573699 DOI: 10.1111/ner.12369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/08/2015] [Accepted: 10/01/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Shuo Chen
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
- Graduate School; Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Yanmei Li
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
| | - Shukun Yao
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
- Graduate School; Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Yanli Zhang
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
| | - Liang Liu
- Department of Gastroenterology; Jinan Central Hospital Affiliated to Shandong University; Jinan China
| | - Xiaojuan Guo
- Department of Gastroenterology; Beijing Tsinghua Chang Gung Hospital; Beijing China
| | - Wang Chen
- Institute of Clinical Medicine; China-Japan Friendship Hospital; Beijing China
| | - Yan Chen
- Department of Radiology; China-Japan Friendship Hospital; Beijing China
| | - Yuhui Du
- Rishena Technology Development Co. Ltd.; Changzhou China
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Li Y, Yao S, Chen S, Zhang Y, Guo X, Zhang W, Guo W. The acute effects of a new type of implantable gastric electrical stimulators featuring varied pulse widths on beagle dogs' food intake and gastric accommodation. Obes Surg 2015; 24:783-90. [PMID: 24362579 DOI: 10.1007/s11695-013-1158-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To improve the therapeutic effects of gastric electrical stimulation (GES) for obesity, an animal experiment was conducted using a new type of stimulators. Proper parameters of GES were selected, and the impacts of GES on the food intake and gastric accommodation of canines were observed. METHODS Eight beagle dogs were operated on, and GES was performed on them. Firstly, GES was performed to determine the right parameters according to symptoms. Secondly, the so selected parameters were used in a 3-day GES procedure, during which process food intake, body weight, and symptoms were recorded. Thirdly, the gastric capacities before and after GES with different pulse widths were measured by means of a barostat. RESULTS The selected parameters varied for each dog, with the pulse widths ranging from 0.3 to 6 ms. The food consumption after GES dropped significantly as compared with the amount observed in the sham stimulation. Tolerance to stimulation could be observed during GES. The post-GES gastric fundus capacity increased evidently in comparison with the capacity before GES, suggesting significant distention as compared with sham stimulation. Given an increment of 2 ms in the pulse width twice, the gastric capacity continued to distend each time. CONCLUSIONS GES featuring pulse trains with wider and individualized pulse widths could inhibit food consumption of dogs. The stimulation parameters should be selected individually and adjusted periodically. GES of this mode could also increase the fasting gastric capacity with certain dose-related effects. The new type of stimulators may be more suitable for the treatment of human obesity than traditional stimulators.
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Affiliation(s)
- Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, China
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Abstract
Background Gastric electrical stimulation (GES) has been proposed as a promising therapeutic option in treating obesity for 20 years. Currently, the available device of GES cannot meet the clinical needs. The purpose of this study is to verify the effect of a new type of adjustable gastric electrical stimulator in reducing food intake and body weight. Methods Eight beagle dogs randomly followed GES and sham GES for 3 months in a crossover design. Parameters were adjusted and individualized during the experiment. Symptoms of GES were recorded, and the effective parameters were selected. Resistance to GES was assessed. Food intake and body weight were measured to evaluate the effect of GES. Results The effective parameters were varied among the dogs. Resistance to GES was observed in different periods in dogs. Parameters needed to be adjusted every 10.2 ± 2.1 days during the period of GES. Food intake during GES for 3 months was significantly reduced than that during sham GES of 3 months (P < 0.05). With the decreased food intake, body weight was significantly reduced by the end of GES of 3 months compared with that of sham GES of 3 months (P < 0.05). Conclusions Food intake and body weight of dogs are significantly reduced by adjustable GES. Individual parameters and resistance during GES are required to be considered. The new adjustable device may have good prospects of clinical application for obesity.
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Guo X, Li Y, Yao S, Chen S, Du Y, Wang Z. The effects of individualized gastric electrical stimulation on food craving and gastrointestinal peptides in dogs. Neuromodulation 2014; 17:483-8; discussion 488-9. [PMID: 24961651 DOI: 10.1111/ner.12207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/13/2014] [Accepted: 03/24/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Using an adjustable stimulator with a wide range of stimulation parameters, the aims of this study were 1) to investigate the effects of long-term gastric electrical stimulation (GES) on appetite and differential food cravings for three different foods and 2) to investigate the effects of GES on plasma gastrointestinal peptide concentrations. METHODS The study was performed in eight Beagle dogs implanted with one pair of serosal electrodes. They were followed during GES and sham GES sessions in a crossover design. GES was conducted using a series of individualized parameters. Food intake and food cravings were observed to evaluate the effects of long-term GES. Enzyme-linked immunosorbent assay was used to measure the plasma concentrations of gastrointestinal peptides. RESULTS Dogs on GES for three months ate significantly less food than those on sham GES for three months (p < 0.05). A significant change in food cravings was induced by GES. Dogs with GES ate significantly less high-fat food. However, there was no significant difference in consumption of high-carbohydrate food or balanced food between the periods of GES and sham GES. The plasma concentrations of ghrelin, peptide YY3-36, and glucagon-like peptide 1 did not differ significantly between the periods of GES and sham GES. CONCLUSIONS Food intake and food craving were changed significantly by adjustable GES. GES may be used for treating obesity by changing food preferences. Further clinical studies are necessary to highlight the effect of adjustable GES on eating behavior.
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Affiliation(s)
- Xiaojuan Guo
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
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Ruiz-Tovar J, Oller I, Diez M, Zubiaga L, Arroyo A, Calpena R. Percutaneous Electrical Neurostimulation of Dermatome T6 for Appetite Reduction and Weight Loss in Morbidly Obese Patients. Obes Surg 2013; 24:205-11. [DOI: 10.1007/s11695-013-1091-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mizrahi M, Ben Ya'acov A, Ilan Y. Gastric stimulation for weight loss. World J Gastroenterol 2012; 18:2309-19. [PMID: 22654422 PMCID: PMC3353365 DOI: 10.3748/wjg.v18.i19.2309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/02/2011] [Accepted: 04/28/2012] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity is growing to epidemic proportions, and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss. Behavior and lifestyle therapy are safe treatments for obesity in the short term, but the durability of the weight loss is limited. Although promising obesity drugs are in development, the currently available drugs lack efficacy or have unacceptable side effects. Surgery leads to long-term weight loss, but it is associated with morbidity and mortality. Gastric electrical stimulation (GES) has received increasing attention as a potential tool for treating obesity and gastrointestinal dysmotility disorders. GES is a promising, minimally invasive, safe, and effective method for treating obesity. External gastric pacing is aimed at alteration of the motility of the gastrointestinal tract in a way that will alter absorption due to alteration of transit time. In addition, data from animal models and preliminary data from human trials suggest a role for the gut-brain axis in the mechanism of GES. This may involve alteration of secretion of hormones associated with hunger or satiety. Patient selection for gastric stimulation therapy seems to be an important determinant of the treatment’s outcome. Here, we review the current status, potential mechanisms of action, and possible future applications of gastric stimulation for obesity.
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Du P, O'Grady G, Davidson JB, Cheng LK, Pullan AJ. Multiscale modeling of gastrointestinal electrophysiology and experimental validation. Crit Rev Biomed Eng 2011; 38:225-54. [PMID: 21133835 DOI: 10.1615/critrevbiomedeng.v38.i3.10] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Normal gastrointestinal (GI) motility results from the coordinated interplay of multiple cooperating mechanisms, both intrinsic and extrinsic to the GI tract. A fundamental component of this activity is an omnipresent electrical activity termed slow waves, which is generated and propagated by the interstitial cells of Cajal (ICCs). The role of ICC loss and network degradation in GI motility disorders is a significant area of ongoing research. This review examines recent progress in the multiscale modeling framework for effectively integrating a vast range of experimental data in GI electrophysiology, and outlines the prospect of how modeling can provide new insights into GI function in health and disease. The review begins with an overview of the GI tract and its electrophysiology, and then focuses on recent work on modeling GI electrical activity, spanning from cell to body biophysical scales. Mathematical cell models of the ICCs and smooth muscle cell are presented. The continuum framework of monodomain and bidomain models for tissue and organ models are then considered, and the forward techniques used to model the resultant body surface potential and magnetic field are discussed. The review then outlines recent progress in experimental support and validation of modeling, and concludes with a discussion on potential future research directions in this field.
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Affiliation(s)
- Peng Du
- Auckland Bioengineering Institute, The University of Auckland, New Zealand.
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Weiss R. Devices for the treatment of obesity: will understanding the physiology of satiety unravel new targets for intervention? J Diabetes Sci Technol 2008; 2:501-8. [PMID: 19885218 PMCID: PMC2769726 DOI: 10.1177/193229680800200323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The rise in the prevalence of obesity in the last few decades and its growing impact on health has driven the scientific community to investigate the physiological basis of energy homeostasis and mechanisms of satiety, and seek targets for intervention against this burgeoning epidemic. Recent findings highlight the role of gut-derived, hormonal signals in the regulation of satiety. These hormones act together with the dense and intricate enteric nervous system to coordinate and regulate gastrointestinal satiety signals, motility, and digestive processes. Bariatric surgical approaches attempt to take advantage of these mechanisms to facilitate early satiety and weight loss. Some of these procedures, by altering the anatomical structure of the upper gastrointestinal tract, also modify the hormonal response to food. Similarly, devices such as volume-occupying elements and nerve stimulators attempt to alter the gastrointestinal milieu in a manner that will ultimately lead to long-term weight loss. Novel surgical, endoscopic, and device-oriented methodologies seem to be promising approaches to treat obesity, yet further research is needed to appreciate their long-term effect.
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Affiliation(s)
- Ram Weiss
- Department of Human Nutrition and Metabolism, and the Department of Pediatrics, Hebrew University Medical School, Jerusalem, Israel.
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A new laparoscopic technique for weight reduction with implanted gastric banding basket. Obes Surg 2008; 18:353-8. [PMID: 18253804 DOI: 10.1007/s11695-007-9366-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nowadays, obesity is frequently an indication for implantation of an adjustable stomach or gastric band. Among the side effects, in addition to band erosion and port chamber complications, pouch dilation in the sense of increasing enlargement of the forestomach and resulting insufficiency of initial surgical measures consistently occurs. Implantation of a soft basket band will prevent this. The objective of this study was to investigate the practical feasibility of the soft basket band. METHODS Ten patients were investigated in an observation study over a period from November 2006 to June 2007. Seven patients were women and three patients were men, with an average age of 43.6 years (25-66 years). RESULTS The average body mass index (BMI) at the time of the operation was 47.4 +/- 5.5 kg/m(2), with an average body weight of 134.5 +/- 24.6 kg. After a median follow-up period of 1 month, an average BMI of 44.9 +/- 5.8 kg/m(2) was achieved, and after 3 months, an average BMI of 41.4 +/- 4.8 kg/m(2). The excessive weight loss was 7.4 +/- 4.3 kg after 1 month and 17.9 +/- 6.4 kg after 3 months. A local wound infection occurred as a complication in one patient. CONCLUSION Laparoscopy procedures enable mortality to be lowered compared to bypass operations with minimal complications and substantial reduction of weight.
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Abstract
The prevalence of obesity is growing, is driving an increase in the prevalence of diabetes, and is creating a major public health crisis in the United States. Lifestyle and behavior therapy rarely give durable weight loss. There are few medications approved for the treatment of obesity. Those that exist are limited in efficacy and using them in combination does not result in greater weight loss. Surgical treatments for obesity are effective and give durable weight loss, but are accompanied by measurable morbidity and mortality. Several pacing approaches are being tried and are an outgrowth of pacing for gastroparesis. The Transcend(R) pacemaker blocks vagal efferents and delays gastric emptying, giving a 40% loss of excess body weight, if certain screening procedures are employed. The Tantulus pacemaker is still in development but increases antral muscular contractions and delays gastric emptying by stimulation during the absolute refractory period. Weight loss has been 30% of excess body weight, and glycohemoglobin decreased 1.6% in a trial of obese type 2 diabetes. Stimulation to the subdiaphragmatic sympathetics, vagal nerve stimulation with or without unilateral vagotomy, and intestinal pacing are other approaches that are still being evaluated preclinically. Clearly a safe, effective, and durable treatment for obesity is desperately needed. Electrical pacing of the gastrointestinal tract is promising therapeutically, and because pacemakers work through different mechanisms, combining pacemaker treatments may be possible. Rapid progress is being made in the field of electrical stimulation as a treatment for obesity and even greater progress can be expected in the foreseeable future.
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Affiliation(s)
- Frank Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana 70808, USA.
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