Pacing the human stomach

Abstract

The aim of this study was to document the pattern of human gastric pacesetter potentials after abdominal operation and to determine whether the potentials could be paced by electrical stimuli. Ten patients undergoing cholecystectomy had temporary serosal electrodes positioned along the greater curvature of the stomach. Bipolar myoelectric recordings and attempts at electrical pacing were made after operation. On postoperative day 1, the pacesetter potentials had a regular frequency (3.2 +/- 0.1 cycles/min), and no gastric dysrhythmias were evident. The distal stomach of nine of ten patients could be entrained by pacing the proximal electrodes (forward pacing) to a maximal rate of 4.3 +/- 0.3 cycles/min (p less than 0.05 versus nonpacing) without a change in propagation velocity or direction. Backward pacing (maximum rate, 3.9 +/- 0.2 cycles/min) was possible in six patients. Forward pacing was successful by day 3 in only four of ten patients, and backward pacing was successful in none of ten patients. A meal given a median of 3.5 days after operation did not change the pacesetter potential frequency, rhythm, or direction of propagation, and three of ten patients had successful forward pacing after a meal. In conclusion, a regular pattern of gastric pacesetter potentials is present after cholecystectomy. The gastric pacesetter potentials can be paced with electrical stimuli, although refinements of the pacing electrodes or stimuli will be needed to achieve long-term pacing. Pacing holds promise as a potential treatment for gastric myoelectrical disorders.