Characterisation of Gastric Conduit Electrophysiology in Post-Oesophagectomy Patients Using Gastric Alimetry

Background Delayed gastric conduit emptying (DGCE) is a significant functional complication following oesophagectomy, that adversely impacts on patient quality of life and nutritional outcomes. The underlying pathophysiology remains poorly understood but is thought to be a result of surgical transection of vagus nerves, leading to abnormal gastric myoelectrical activity and impaired conduit motility. This study aimed to investigate symptom burden and gastric myoelectrical abnormalities using a non-invasive body surface gastric mapping (BSGM) device in post-oesophagectomy patients. Methods Patients who had previously undergone oesophagectomy with gastric conduit reconstruction were recruited. BSGM was performed using the Gastric Alimetry system, which comprises a high-resolution 64-channel electrode array, a wearable data reader, and a validated symptom-logging application. Patient-reported outcomes, including Konradsson’s DGCE questionnaire, were recorded and analysed in conjunction with myoelectrical data. Results Nineteen patients were recruited, with a mean time of 45.4 months from oesophagectomy. Gastric Alimetry analysis identified four phenotypes: normal, dysrhythmic (low ‘rhythm index’), low frequency, and low amplitude. Patients in the dysrhythmic group exhibited a stronger association with DGCE, reflecting an underlying neuromuscular dysfunction characterised by unstable slow-waves. Interim results also revealed correlations between amplitude and symptom burden (r = 0.47; p = 0.042) and frequency and symptom burden (r = 0.51; p = 0.032). Conclusion This study demonstrates that Gastric Alimetry can stratify post-oesophagectomy patients into distinct gastric myoelectrical phenotypes, providing novel insights into the functional complications following surgery. These findings highlight the potential of non-invasive gastric mapping in the diagnosis and management of DGCE and other post-oesophagectomy disorders.