J Neurogastroenterol Motil  https://doi.org/10.5056/jnm19045
Five-fold Gastrointestinal Electrical Stimulation With Electromyography-based Activity Analysis: Towards Multilocular Theranostic Intestinal Implants
Jonas F Schiemer,1 Axel Heimann,2 Karin H Somerlik-Fuchs,3 Roman Ruff,4 Klaus-Peter Hoffmann,4 Jan Baumgart,5 Manfred Berres,6 Hauke Lang,1 and Werner Kneist1*
1Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
2Institute for Neurosurgical Pathophysiology, University Medicine of the Johannes GutenbergUniversity Mainz, Mainz, Germany
3Department of Research and Development at inomed Medizintechnik GmbH, Emmendingen, Germany
4Department of Biomedical Engineering, Fraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
5Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
6Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz and RheinAhrCampus of the University of Applied Sciences Koblenz, Remagen, Germany
Correspondence to: Werner Kneist, MD
Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131 Mainz, Germany
Tel: +49-6131-17-7291, Fax: +49-6131-17-6630, E-mail: werner.kneist@unimedizinmainz.de
Received: March 5, 2019; Revised: April 30, 2019; Accepted: May 16, 2019; Published online: June 2, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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Abstract
Background/Aims
Motility disorders are common and may affect the entire gastrointestinal (GI) tract but current treatment is limited. Multilocular sensing of GI electrical activity and variable electrical stimulation (ES) is a promising option. The aim of our study is to investigate the effects of adjustable ES on poststimulatory spike activities in 5 GI segments.
Methods
Six acute porcine experiments were performed with direct ES by 4 ES parameter sets (30 seconds, 25 mA, 500 microseconds or 1000 microseconds, 30 Hz or 130 Hz) applied through subserosal electrodes in the stomach, duodenum, ileum, jejunum, and colon. Multi-channel electromyography of baseline and post-stimulatory GI electrical activity were recorded for 3 minutes with hook needle and hook-wire electrodes. Spike activities were algorithmically calculated, visualized in a heat map, and tested for significance by Poisson analysis.
Results
Post-stimulatory spike activities were markedly increased in the stomach (7 of 24 test results), duodenum (8 of 24), jejunum (23 of 24), ileum (18 of 24), and colon (5 of 24). ES parameter analysis revealed that 80.0% of the GI parts (all but duodenum) required a pulse width of 1000 microseconds, and 60.0% (all but jejunum and colon) required 130 Hz frequency for maximum spike activity. Five reaction patterns were distinguished, with 30.0% earlier responses (type I), 42.5% later or mixed type responses (type II, III, and X), and 27.5% non-significant responses (type 0).
Conclusions
Multilocular ES with variable ES parameters is feasible and may significantly modulate GI electrical activity. Automated electromyography analysis revealed complex reaction patterns in the 5 examined GI segments.
Keywords: Electric stimulation; Electromyography; Gastrointestinal tract


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