Sedatives reduce human gastric slow-wave amplitude, assessed by a multicenter study of endoscopic gastric mapping
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Background
Gastrointestinal (GI) motility disorders are prevalent, impose a significant burden, and are associated with disrupted spatial propagation of bioelectrical gastric slow waves. High-resolution endoscopic gastric mapping (EGM) is an emerging minimally invasive technique for imaging gastric electrical activity; however, EGM is performed alongside standard gastroscopy and requires procedural sedation, which may interact with gastric electrical activity, distorting clinical insights. This study explored the influence of procedural sedation on EGM-recorded slow-wave activity.
Methods
EGM was performed for ∼7 min in 32 patients undergoing upper GI endoscopy at two New Zealand hospitals. Endoscopists administered procedural sedation (fentanyl and midazolam) according to best clinical practice. The relationship between slow-wave amplitude and patient characteristics was then investigated using a variety of statistical techniques.
Key Results
Gastric slow waves were detected in 30 of 32 patients who underwent EGM. Symptom scores and demographic measures were comparable between sites. Fentanyl (A, 93.4 ± 13.7 μg vs B, 137.5 ± 33.7 μg, p ≤0.001) and midazolam (A, 5.0 ± 0.9 mg vs B, 7.4 ± 1.6 mg, p ≤0.001) doses were higher at Hospital B than Hospital A. Correspondingly, slow-wave amplitudes were lower at Hospital B than Hospital A (A, 2.33 ± 1.61 mV vs B, 0.86 ± 1.01 mV, p =0.004). All other slow-wave metrics were consistent between hospitals. Combined sedative dose was negatively correlated with slow-wave amplitude ( p =0.037).
Conclusions & Inferences
Higher procedural sedative doses are associated with lower-amplitude gastric slow-waves. Procedural sedation dose and opiate administration should be carefully considered when interpreting GI electrophysiology measurements.
