Electrogastrography (EGG) and gastric motility: an investigation to evaluate gastric emptying in those who undergo oesophago -gastric anastomosis without a pyloroplasty

Abstract

INTRODUCTION: EGG is a non-invasive technique of recording gastric myoelectrical activity by placing electrodes on the abdomen. Objectives : The aim of this study was to assess the myoclcctrical activity of the stomach following ocsophago-gastric anastomosis without a pyloroplasty and also to correlate the values with those who develop symptoms of gastric stasis. DESIGN,SETTING AND METHODS : We present the initial results of an ongoing study. EGG results of six patients (M:F=5: 1) with carcinoma of the oesophagus who underwent transhiatal oesophagectomy were analysed. Mean age was 56y (range 45-76). EGG was performed preoperatively and three months after surgery using computerised digitrapher EGG (Syncctics, UK). One patient complained of symptoms of gastric stasis and reflux and did not respond to therapy with prokinetic agents. She underwent subsequent pyloroplasty and is asymptomatic at present. RESULTS : All patients showed normal preoperative myoelectrical activity (mean - + 131.17 mv) and motility. Postopcratively all patients showed bradygastria and low myoelectrical activity. Postoperative myoelectrical activity in the asymptomatic group showed a value which was positive (mean - +94.12mv) compared to the symptomatic patient who had a persistent mean negative value (- 89.34 mv). CONCLUSIONS : Persistent negative amplitude in the EGG postoperatively may indicate severe gastric stasis. This may be due to poor contractiliy of the denervatcd stomach in some patients. Therefore pyloroplasty should be considered before these patients develop complications of stasis and reflux.