Subject:
Cutaneous Electrogastrography (EGG)
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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Electrogastrography (EGG) describes the recording and interpretation of electrical activity of the stomach. Recordings can be made from the gastrointestinal mucosa, serosa, or skin surface (cutaneous). Because of its ease of use, cutaneous EGG has been used frequently and is the focus of this policy.
The electrical activity of the stomach can be subdivided into two general categories; electrical control activity (ECA) and electrical response activity (ERA). ECA is characterized by regularly recurring electrical potentials, originating in the gastric pacemaker located in the corpus of the stomach and sweeping in an annular band with increasing velocity toward the pylorus. ECA is not associated with contractions of the stomach unless coupled with action potentials, referred to as ERA. The usual practice is to record several cutaneous EGG signals from various standardized positions of the abdominal wall and to select the one with the highest amplitude for further analysis. Nonetheless, the recorded signal is relatively weak and difficult to distinguish from the surrounding background "noise" related to unwanted signals, such as cardiac, respiratory, duodenal, and colonic electrical activity. For this reason, direct visual analysis of the EGG signals is problematic. Various methods of filtering out background noise and automated analysis have been developed; running spectral analysis is most common. The EGG is usually evaluated in terms of changes in the EGG amplitude and frequency. Deviation from the normal frequency of 3 cycles per minute may be referred to as brady- or tachyarrhythmia.
The use of EGG has been most widely studied in patients with gastroparesis and functional dyspepsia. Gastroparesis is defined as a chronic disorder of gastric motility as evidenced by delayed gastric emptying of a solid meal. Symptoms include bloating, distension, nausea, and vomiting. When severe and chronic, gastroparesis can be associated with dehydration, poor nutritional status, and poor glycemic control in diabetics. While most commonly associated with diabetes, gastroparesis is also found in chronic pseudo-obstruction, connective tissue disorders, Parkinson's disease, and psychological pathology. Functional dyspepsia is an enigmatic disorder characterized by persistent symptoms of abdominal discomfort with no identifiable etiology, including gastric emptying. In this setting, disorders in gastric motility may be considered. Treatment of gastric motility disorders typically include the use of prokinetic agents such as cisapride, domperidone, or metoclopramide.
Scintigraphic gastric emptying is considered the gold standard test for evaluating gastroparesis. The test consists of ingestion of a solid meal spiked with 99-technetium. Serial scintigraphic measurements are then performed every 20 minutes for 2–3 hours after the meal. Delayed gastric emptying is diagnosed if more than 50% of the radiolabelled food is retained at the end of the study period. While gastric emptying evaluates the efficiency of gastric emptying, EGG focuses on the underlying myoelectrical activity.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
Electrogastrography is considered an investigational procedure.
Although electrogastrography appears to be technically feasible, several studies have compared it with gastric emptying scan and have reported a poor correlation between the two tests. Because of its low sensitivity, an abnormal EGG may predict delayed gastric emptying, however a normal EGG will not rule out delayed gastric emptying.
Medicare Coverage:
There is no National Coverage Determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of Local Medicare Carriers. Novitas Solutions, Inc, the Local Medicare Carrier for jurisdiction JL, has not issued a determination for this service. Therefore, Medicare Advantage Products will follow the Horizon BCBSNJ Medical Policy.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Cutaneous Electrogastrography
Electrogastrography
EGG
References:
1. Camilleri M, Hasler WL, Parkman HP, et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology. September 1998;115(3):747-762.
2. Sanmiguel CP, Mintchev MP, Bowes KL. Electrogastrography: a noninvasive technique to evaluate gastric electrical activity. Can J Gastroenterol. September 1998;12(6):423-430.
3. Verhagen MA, Van Schelven LJ, Samsom M, Smout AJPM. Pitfalls in the analysis of electrogastrographic recording. Gastroenterology 1999;117:453-60.
4. Bortolotti M. Electrogastrography: A seductive promise only partially kept. Am J Gastro 1998;93:1791-94.
5. Koch KL, Medina M, Bingaman S, Sterm RM. Gastric dysrhythmia and visceral sensations in patients with functional dyspepsia. Gastroenterology 1992;102:A469.
6. Koch KL, Sterm RM, Stewart WR, Vasey MW. Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis; effect of long term domperidone treatment. Am J Gastroenterol 1989;84:1069-75.
7. Smout AJPM, Jebbink HJ, Akkermans LMA, Bruijs PPM. Role of electrogastrography and gastric impedance measurements in evaluating gastric emptying and motility. Dig Dis Sci 1994;39:110S-3S.
8. Parkman HP, Miller MA, Trate D et al. Electrogastrography and gastric emptying scintigraphy are complementary for assessment of dyspepsia. J Clin Gastroenterol 1997;24:214-19.
9. Chen JDZ, Lin Z, Pan J, McCallum RW. Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci 1996;41:1538-45.
10. Brzana RJ, Koch KL, Bingaman S. Gastric myoelectrical activity in patients with gastric outlet obstruction and idiopathic gastroparesis. Am J Gastroenterol 1998;93:1803-09.
11. Kawagishi T, Nishizawa Y, Emoto M et al. Gastric myoelectrical activity in patients with diabetes: Role of glucose control and autonomic nerve function. Diabetes Care 1997;20:848-53.
12. Mantides A, Stefanides G, Kioulanis J et al. Cutaneous electrogastrography for the assessment of gastric myoelectrical activity in Type 1 diabetes mellitus. Am J Gastroenterol 1997;92:1190-93.
13. Levy J. Use of electrogastrography in children. Curr Gastroenterol Rep 2002 Jun;4(3):259-265.
14. McNearney T, Lin X, Shrestha J, et al. Characterization of gastric myoelectrical rhythms in patients with systemic sclerosis using multichannel surface electrogastrography. Dig Dis Sci 2002 Apr;47(4):690-698.
15. Knippig C, Fass R, Malfertheiner P. Tests for the evaluation of functional gastrointestinal disorders. Dig Dis 2001;19(3):232-239.
16. Lawlor PM, McCullough JA, Byrne PJ, et al. Electrogastrography: a non-invasive measurement of gastric function. Ir J Med Sci 2001 Apr-Jun;170(2):126-131.
17. Kim DY, Myung SJ, Camilleri M. Novel testing of human gastric motor and sensory functions: rationale, methods, and potential applications in clinical practice. Am J Gastroenterol 2000 Dec;95(12):3365-3373.
18. Aktay AN, Splaingard ML, Miller T et al. Electrogastrography in children with cystic fibrosis. Dig Dis Sci 2002;47(4):699-703.
19. Levy J, Harris J, Chen J et al. Electrogastrographic norms in children: toward the development of standard methods, reproducible results, and reliable normative data. J Pediatr Gastroenterol Nutr 2001;33(4):455-61.
20. Koch KL. Electrogastrography: physiological basis and clinical application in diabetic gastropathy. Diabetes Technol Ther 2001;3(1):51-62.
21. Mathur R, Pimentel M, Sam CL et al. Postprandial improvement of gastric dysrhythmias in patients with type II diabetes: identification of responders and nonresponders. Dig Dis Sci 2001:46(4):705-12.
22. Koch KL, Hong SP, Xu L. Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dypepsia symptoms and in control subjects. J Clin Gastroenterol 2000;31(2):125-9.
23. Lin Z, Eaker EY, Sarosiek I et al. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol 1999;94(9):2384-9.
24. American Gastroenterological Association medical position statement: nausea and vomiting. Gastroenterology 2001;120(1):261-3.
25. Botoman VA, Rao S, Dunlap P, et al. Motility and GI function studies billing and coding guidelines: a position paper of the American Motility Society. Am J Gastroenterol 2003 Jun;98(6):1228-36.
26. Parkamn HP, Hasler WL, Barnett JL, et al. Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force. Neurogastroenterol Motil 2003 Apr;15(2):89-102.
27. Chen CL, Lin HH, Chen SY, et al. Utility of Electrogastrography in Differentiating Parkinson’s Disease with or without Gastrointestinal Symptoms: A Prospective Controlled Study. Digestion 2005 May 2;71(3):187-191.
28. Patient information: Gastroparesis. American College of Gastroenterology. August 2004. Available at: http://gi.org/patients/gihealth/gastroparesis.asp (accessed 06/26/06).
29. Parkman HP, Hasler WL, Fischer RS. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology 2004;127(5):1589-91.
30. Abid S, Lindberg G. Electrogastrography: poor correlation with antro-duodenal manometry and doubtful clinical usefulness in adults. World J Gastroenterol 2007 Oct 14;13(38):5101-7.
31. Yin J, Chen JD. Electrograstrography: methodology, validation, and applications. J Neurogastroenterol Motil 2013 Jan;19(1):5-17.
32. Murakami H, Matsumoto H, Ueno D, et al. Current status of multichannel electrogastrography and examples of its use. J Smooth Muscle Res 2013;49:78-88.
33. UpToDate. Gastroparesis: Etiology, clinical manifestations, and diagnosis. Literature review current through May 2016; topic last updated April 9, 2015..
34. UpToDate. Motility testing: When does it help? Literature review current through May 2016; topic last updated April 14, 2014.
35. UpToDate. Approach to the adult with nausea and vomiting. Literature review current through May 2016; topic last updated May 12, 2016.
36. O'Grady G, Wang TH, Du P, et al. Recent progress in gastric arrhythmias: pathophysiology, clincial significance and future horizons. Clin Exp Pharmacol 2014 Oct;41(10):854-62.
37. O'Grady G, Abell TL. Gastric arrhythmias in gastroparesis: low- and high-resolution mapping of gastric electrical activity. Gastroenterol Clin North Am 2015 Mar;44(1):169-84.
38. Lembo AJ. Overview of Gastrointestinal motility testing. In: UpToDate, Talley NJ, Grover S (Eds), UpToDate, Waltham, MA. (Accessed on May 1, 2017.)
39. Longstreth GF. Approach to the adult with nausea and vomiting. In: UpToDate, Talley NJ, Grover S (Eds). UpToDate, Waltham, MA. (Accessed on May 1, 2017.)
40. Camilleri M. Gastroparesis: Etiology, clinical manifestations, and diagnosis. In: UpToDate, Talley NJ, Grover S (Eds) UpToDate, Waltham, MA. (Accessed on May 1, 2017.)
41. Camilleri M. Gastroparesis: Etiology, clinical manifestations, and diagnosis. In: UpToDate, Talley NJ, Grover S (Eds) UpToDate, Waltham, MA. (Accessed on April 2, 2018.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
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