Measurement of gastric emptying of a high-nutrient liquid by 3D ultrasonography in diabetic gastroparesis

Abstract

Gastric emptying (GE) is delayed in 30-50% of patients with longstanding diabetes. Scintigraphy represents the 'gold standard' for measurement of GE, but is associated with a radiation burden. Three-dimensional (3D) ultrasonography has recently been demonstrated to provide a valid measure of liquid GE in healthy subjects; however, the technique has not been validated in patients with gastroparesis. The primary aim of this study was to compare measurements of GE of a high-nutrient glucose drink by 3D ultrasonography and scintigraphy in diabetic gastroparesis. Ten patients (eight type 1, two type 2, 6M, 4F, aged 46.1 ± 4.5 years, BMI 29.1 ± 1.6 kg m(-2), duration 19.6 ± 3.3 years) with diabetic gastroparesis [defined as retention at 100 min of solid (100 g minced beef) ≥ 61% and/or 50% emptying time (T50) of liquid (150 mL 10% dextrose) ≥ 31 min], were studied. Concurrent measurements of GE by scintigraphy and 3D ultrasonography were performed following ingestion of 75 g glucose in 300 mL water labeled with 20 MBq (99m) Tc-sulfur colloid. There was no significant difference in GE between the two techniques (T50s: scintigraphy - 103.3 ± 10.0 min VS 3D ultrasonography - 98.8 ± 10.4 min; P = 0.60). There was a significant correlation between scintigraphic and ultrasonographic T50s (r = 0.67, P = 0.03). The limits of agreement for the T50s were -57.22 min and +48.22 min (mean difference -4.5 min). Blood glucose after the drink was greater when GE was relatively more rapid (e.g. at t = 60 min; scintigraphy: r = -0.65, P = 0.04; 3D ultrasonography: r = -0.78, P = 0.008). Three-dimensional ultrasonography appears to provide a valid, and non-invasive, measure of GE of high-nutrient liquids in diabetic gastroparesis.