Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine , Stanford, California.
G-Tech Medical, Fogarty Institute of Innovation , Mountain View, California.
Am J Physiol Gastrointest Liver Physiol. 2018 Nov 1;315(5):G743-G751. doi: 10.1152/ajpgi.00074.2018. Epub 2018 Jul 26.
Postoperative delayed gastric emptying (DGE) is a frustrating complication of pancreaticoduodenectomy (PD). We studied whether monitoring of postoperative gastric motor activity using a novel wireless patch system can identify patients at risk for DGE. Patients ( n = 81) were prospectively studied since 2016; 75 patients total were analyzed for this study. After PD, battery-operated wireless patches (G-Tech Medical) that acquire gastrointestinal myoelectrical signals are placed on the abdomen and transmit data by Bluetooth. Patients were divided into early and late groups by diet tolerance of 7 days [enhanced recovery after surgery (ERAS) goal]. Subgroup analysis was done of patients included after ERAS initiation. The early and late groups had 50 and 25 patients, respectively, with a length of stay (LOS) of 7 and 11 days ( P < 0.05). Nasogastric insertion was required in 44% of the late group. Tolerance of food was noted by 6 versus 9 days in the early versus late group ( P < 0.05) with higher cumulative gastric myoelectrical activity. Diminished gastric myoelectrical activity accurately identified delayed tolerance to regular diet in a logistical regression analysis [area under the curve (AUC): 0.81; 95% confidence interval (CI), 0.74-0.92]. The gastric myoelectrical activity also identified a delayed LOS status with an AUC of 0.75 (95% CI, 0.67-0.88). This stomach signal continued to be predictive in 90% of the ERAS cohort, despite earlier oral intake. Measurement of gastric activity after PD can distinguish patients with shorter or longer times to diet. This noninvasive technology provides data to identify patients at risk for DGE and may guide the timing of oral intake by gastric "readiness." NEW & NOTEWORTHY Limited clinical indicators exist after pancreaticoduodenectomy to allow prediction of delayed gastric emptying (DGE). This study introduces a novel, noninvasive, wireless patch system capable of accurately monitoring gastric myoelectric activity after surgery. This system can differentiate patients with longer or shorter times to a regular diet as well as provide objective data to identify patients at risk for DGE. This technology has the potential to individualize feeding regimens based on gastric activity patterns to improve outcomes.
术后胃排空延迟（DGE）是胰十二指肠切除术（PD）的一种令人沮丧的并发症。我们研究了使用新型无线贴片系统监测术后胃动力活动是否可以识别发生 DGE 的风险患者。自 2016 年以来，前瞻性研究了 81 例患者；对 75 例患者进行了本研究分析。PD 后，将可通过蓝牙传输数据的电池供电无线贴片（G-Tech Medical）放置在腹部。根据术后 7 天的饮食耐受情况（加速康复外科（ERAS）目标），患者分为早期和晚期两组。对 ERAS 开始后纳入的患者进行了亚组分析。早期组和晚期组分别有 50 例和 25 例患者，住院时间（LOS）分别为 7 天和 11 天（P<0.05）。晚期组中 44%的患者需要插入鼻胃管。早期组和晚期组的食物耐受时间分别为 6 天和 9 天（P<0.05），累积胃电活动更高。逻辑回归分析表明，胃电活动减少准确识别了常规饮食的延迟耐受[曲线下面积（AUC）：0.81；95%置信区间（CI），0.74-0.92]。胃电活动也以 AUC 为 0.75（95%CI，0.67-0.88）识别了 LOS 延迟状态。尽管开始口服摄入较早，但该胃信号在 90%的 ERAS 队列中仍然具有预测性。PD 后胃活动的测量可以区分饮食时间较短或较长的患者。这项非侵入性技术提供了数据，可以识别发生 DGE 的风险患者，并可能通过胃“准备”来指导口服摄入的时间。
胰十二指肠切除术后，预测胃排空延迟（DGE）的临床指标有限。本研究介绍了一种新型的、非侵入性的、无线贴片系统，能够准确监测手术后的胃电活动。该系统可以区分饮食时间较长或较短的患者，还可以提供客观数据来识别发生 DGE 的风险患者。该技术有可能根据胃活动模式来个性化喂养方案，以改善结果。
