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Colon Myoelectric Activity Measured After Open Abdominal Surgery with a Noninvasive Wireless Patch System Predicts Time to First Flatus

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Passage of flatus after abdominal surgery signals resolution of physiological postoperative ileus (POI) and often, particularly after complex open surgeries, serves as the trigger to initiate oral feeding. To date, there is no objective tool that can predict time to flatus allowing for timely feeding and optimizing recovery. In an open, prospective study, we examine the use of a noninvasive wireless patch system that measures electrical activity from gastrointestinal smooth muscles in predicting time to first flatus.

Methods

Eighteen patients who underwent open abdominal surgery at El Camino Hospital, Mountain View, CA, were consented and studied. Immediately following surgery, wireless patches were placed on the patients’ anterior abdomen. Colonic frequency peaks in the spectra were identified in select time intervals and the area under the curve of each peak times its duration was summed to calculate cumulative myoelectrical activity.

Results

Patients with early flatus had stronger early colonic activity than patients with late flatus. At 36 h post-surgery, a linear fit of time to flatus vs cumulative colonic myoelectrical activity predicted first flatus as much as 5 days (± 22 h) before occurrence.

Conclusions

In this open, prospective pilot study, noninvasive measurement of colon activity after open abdominal surgery was feasible and predictive of time to first flatus. Interventions such as feeding can potentially be optimized based on this prediction, potentially improving outcomes, decreasing length of stay, and lowering costs.

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References

  1. Luckey A, Livingston E, Taché Y. Mechanisms and treatment of postoperative ileus. Arch Surg. 2003;138:206–14.

    Article  PubMed  Google Scholar 

  2. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus. World J Surg. 2006;30:1382–91.

    Article  PubMed  Google Scholar 

  3. Kehlet H, Holte K. Review of postoperative ileus. Am J Surg. 2001;182:3S–10S.

    Article  CAS  PubMed  Google Scholar 

  4. Ahmed J, Mehmood S, MacFie J. Postoperative Ileus in Elective Colorectal Surgery: Management Strategies. Contemp Issues Color Surg Pract. 2012. p. 35–54.

  5. Goldstein JL, Matuszewski K A, Delaney CP, Senagore A, Chiao EF, Shah M, et al. Inpatient Economic Burden of Postoperative Ileus Associated with Abdominal Surgery in the United States. P&T. 2007;32:82–90.

    Google Scholar 

  6. Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm. 2009;15:485–94.

    PubMed  Google Scholar 

  7. Flynn DN, Speck RM, Mahmoud NN, David G, Fleisher LA. The impact of complications following open colectomy on hospital finances: a retrospective cohort study. Perioper Med. 2014;3:1.

    Article  Google Scholar 

  8. Van Bree SHW, Bemelman WA, Hollmann MW, Zwinderman AH, Matteoli G, El Temna S, et al. Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus. Ann Surg. 2014;259:708–14.

    Article  PubMed  Google Scholar 

  9. Grass F, Slieker J, Jurt J, Kummer A, Solà J, Hahnloser D, et al. Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study. Int J Colorectal Dis. 2017;32:675–81.

    Article  PubMed  Google Scholar 

  10. Read TE, Brozovich M, Andujar JE, Ricciardi R, Caushaj PF. Bowel Sounds Are Not Associated with Flatus, Bowel Movement, or Tolerance of Oral Intake in Patients after Major Abdominal Surgery. Dis Colon Rectum. 2017;60:608–13.

    Article  PubMed  Google Scholar 

  11. Waldhausen JH, Shaffrey ME, Skenderis BS, Jones RS, Schirmer BD. Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg. 1990;211:777–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Massey RL. Return of bowel sounds indicating an end of postoperative ileus: is it time to cease this long-standing nursing tradition? Medsurg Nurs. 2012;21:146–50.

    PubMed  Google Scholar 

  13. Sarna SK. Physiology and pathophysiology of colonic motor activity. Dig Dis Sci. 1991;36:827–62.

    Article  CAS  PubMed  Google Scholar 

  14. Condon, R E, Cowles, Verne, Schulte, William J, Frantzides, Constantinos, Matsumoto T. The effect of whole gut lavage on colon motility and gastrocolic response in the subhuman primate. Surgery. 1986;99:531–6.

  15. Sarna SK. Myoelectric correlates of colonic motor complexes and contractile activity. Am J Physiol. 1986;250:G213–20.

    CAS  PubMed  Google Scholar 

  16. Sarna SK, Waterfall WE, Bardakjian BL. Types of human colonic electrical activities recorded postoperatively. Gastroenterology. 1981;81:61–70.

    Article  CAS  Google Scholar 

  17. Condon RE, Frantzides CT, Cowles VE, Mahoney JL, Schulte WJ, Sarna SK. Resolution of postoperative ileus in humans. Ann Surg. 1986;203:574–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Condon RE, Cowles VE, Ferraz AA, Carilli S, Carlson ME, Ludwig K, et al. Human colonic smooth muscle electrical activity during and after recovery from postoperative ileus. Am J Physiol. 1995;269:G408–17.

    CAS  PubMed  Google Scholar 

  19. Axelrod S, Navalgund AR, Axelrod LA, Triadafilopoulos G. Mo1591 - A New Motility Tool: High Concordance Between Internal Smartpill Pressure Recordings and Myoelectric Events Measured by External Wireless G-Tech Patches. Gastroenterology [Internet]. Elsevier; 2018;154:S-763. Available from: https://doi.org/10.1016/S0016-5085(18)32642-8

  20. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW. Case-Matched Comparison of Clinical and Financial Outcome after Laparoscopic or Open Colorectal Surgery. Ann Surg. 2003;238:67–72.

    PubMed  PubMed Central  Google Scholar 

  21. Shapiro SB, Bray MS, Appel AL, Kallies KJ, Borgert AJ, Zinnel BA. Implementation of an Enhanced Recovery After Surgery Program for Colorectal Surgery at a Community Teaching Hospital. Wmj. 2017;22–7.

  22. Frantzides, C T, Cowles, Verne, Salaymeh, Basil, Tekin, Ercument Condon, Robert. Morphine effects on human colonic myoelectrical activity in the postoperative period. Am J Surg. 1992;163:144–9.

    Article  CAS  PubMed  Google Scholar 

  23. Wolff BG, Michelassi F, Gerkin TM, Techner L, Gabriel K, Du W, et al. Alvimopan, a novel, peripherally acting μ opioid antagonist: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg. 2004;240:728–35.

    PubMed  PubMed Central  Google Scholar 

  24. Drake TM, Ward AE. Pharmacological management to prevent ileus in major abdominal surgery: a systematic review and meta-analysis. J. Gastrointest. Surg. 2016. p. 1253–64.

  25. Taylor I, Duthie HL, Smallwood RH, Linkens D. Large bowel myoelectrical activity in man. Gut. 1975;16:808–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dinning PG, Szczesniak MM, Cook IJ. Twenty-four hour spatiotemporal mapping of colonic propagating sequences provides pathophysiological insight into constipation. Neurogastroenterol Motil. 2008;20:1017–21.

    Article  CAS  PubMed  Google Scholar 

  27. Smith TK, Park KJ, Hennig GW. Colonic migrating motor complexes, high amplitude propagating contractions, neural reflexes and the importance of neuronal and mucosal serotonin. J Neurogastroenterol Motil. 2014;20:423–46.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sarna SK. Colonic motility: from bench side to bedside. Colloquium Series on Integrated Systems Physiology: From Molecule to Function. Morgan & Claypool Life Sciences.; 2010.

  29. Stoddard CJ, Duthie HL, Smallwood RH, Linkens DA. Colonic myoelectrical activity in man: Comparison of recording techniques and methods of analysis. Gut. 1979;20:476–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bharucha AE. High amplitude propogated contractions. Neurogastroenterol Motil. 2012;24:977–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Huizinga JD, Stern HS, Chow E, Diamant NE, El-Sharkawy TY. Electrophysiologic control of motility in the human colon. Gastroenterology. 1985;88:500–11.

    Article  CAS  PubMed  Google Scholar 

  32. Christensen J, Schedl HP, Clifton JA. The small intestinal basic electrical rhythm (slow wave) frequency gradient in normal men and in patients with a variety of diseases. Gastroenterology. The Williams & Wilkins Company; 1966;50:309–15.

    Article  CAS  Google Scholar 

  33. Chang F, Lu C, Chen C, Luo J, Lee S, Wu H CJ. Fasting and postprandial small intestinal slow waves non-invasively measured in subjects with total gastrectomy. J Gastroenterol Hepatol. 2007;22:247–52.

    Article  PubMed  Google Scholar 

  34. Chen, Jian De, Schinner, D, McCallum RW. Measurement of small Intestine slow wave electrical activity with surface electrodes. IEEE Trans Biomed Eng. 1993;40.

  35. Yin J, Chen JDZ. Electrogastrography: Methodology, validation and applications. J Neurogastroenterol Motil. 2013;19:5–17.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Ryan Schroeder, Director of Clinical Research, and his team at the El Camino Hospital, Mountain View, CA, for their help in recruiting and consenting patients for the study.

Grant Support

Work supported in part by a grant from the Kenneth Rainin Foundation. This work also received support from the Fogarty Institute for Innovation and Breakout Labs.

Author information

Authors and Affiliations

  1. G-Tech Medical, Fogarty Institute for Innovation, 2490 Hospital Drive, Suite 310, Mountain View, CA, 94040, USA

    Anand Navalgund, Steve Axelrod & Lindsay Axelrod

  2. El Camino Hospital, 2500 Grant Road, Mountain View, CA, 94040, USA

    Shyamali Singhal

  3. Palo Alto Medical Foundation, Sutter Health, 701 E El Camino Real, Mountain View, CA, 9404, USA

    Khoi Tran & Prithvi Legha

  4. Department of Medicine, Division of Gastroenterology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    George Triadafilopoulos

Authors
  1. Anand Navalgund
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  2. Steve Axelrod
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  3. Lindsay Axelrod
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  4. Shyamali Singhal
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  5. Khoi Tran
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  6. Prithvi Legha
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  7. George Triadafilopoulos
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Contributions

Study design: AN, SA, SS, GT

Acquisition of data: AN, SA, LA, SS, KT, PL

Analysis and interpretation: AN, SA, LA, SS, KT, PL, GT

Manuscript draft: AN, SA, KT, GT

Critical review and revision: AN, SA, SS, KT, GT

Corresponding author

Correspondence to Anand Navalgund.

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Conflict of interest

Authors SA, LA, and AN are employees of G-Tech Medical. Author GT is an advisor to G-Tech Medical. Patches for this study were supplied by G-Tech Medical.

Additional information

Poster presentation

The work was presented as a poster at the 2018 Digestive Disease Week (DDW) held in Washington D.C, June 2018.

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Navalgund, A., Axelrod, S., Axelrod, L. et al. Colon Myoelectric Activity Measured After Open Abdominal Surgery with a Noninvasive Wireless Patch System Predicts Time to First Flatus. J Gastrointest Surg 23, 982–989 (2019). https://doi.org/10.1007/s11605-018-4030-4

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  • DOI: https://doi.org/10.1007/s11605-018-4030-4

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