Minimally-invasive temporary gastric stimulation: A pilot study to predict the outcome of electronic gastric stimulation with the Enterra™ system.

INTRODUCTION: Gastroparesis (GP) is defined as delayed gastric emptying (GE) without any obstruction of the pylorus. It can be divided into idiopathic, diabetic, post surgical and rare causes. Electronic gastric stimulation (EGS) - Enterra Medtronic™ - is a part of GP therapy. Although its positive impact has been reported in open label trials, randomized controlled trials failed in demonstrating a positive outcome. The aim of this pilot study was to establish a reliable prediction for permanent gastric stimulation. PATIENTS AND PROCEDURE: 6 female patients underwent laparoscopic implantation of 2 temporary electrodes. The Enterra™ system was connected and taped to the skin. Baseline and postoperative gastroparesis cardinal symptom index (GCSI), a validated index for GP therapy, was assessed. Response to EGS was defined as a 50% decrease of baseline GCSI. RESULTS: 4 of 6 patients responded to temporary EGS. 3 of 4 responders underwent permanent implantation. 1 non-responder received a permanent Enterra™ at another institution. After a median follow up time of 9months the responder group GCSI remained low, whereas the non-responder GCSI had increased. Moreover, the health care system was saved € 30,678.03 by this test stimulation concept. CONCLUSION: Laparoscopic implantation of a temporary EGS system predicts the outcome of permanent gastric stimulation and is cost-saving.

Tracking Structural Changes in Lipid-based Multicomponent Food Materials due to Oil Migration by Microfocus Small-Angle X-ray Scattering.

One of the major problems in the confectionery industry is chocolate fat blooming, that is, the formation of white defects on the chocolate surface due to fat crystals. Nevertheless, the mechanism responsible for the formation of chocolate fat blooming is not fully understood yet. Chocolate blooming is often related to the migration of lipids to the surface followed by subsequent recrystallization. Here, the migration pathway of oil into a cocoa butter matrix with different dispersed particles was investigated by employing microfocus small-angle X-ray scattering and contact angle measurements. Our results showed that the chocolate powders get wet by the oil during the migration process and that the oil is migrating into the pores within seconds. Subsequently, cocoa butter is dissolved by the oil, and thus, its characteristic crystalline structure is lost. The chemical process provoked by the dissolution is also reflected by microscopical changes of the surface morphology of chocolate model samples after several hours from the addition of oil to the sample. Finally, the surface morphology was investigated before and after oil droplet exposure and compared to that of water exposure, whereby water seems to physically migrate through the particles, namely cocoa powder, sucrose, and milk powder, which dissolve in the presence of water.