PTH-032 Scintigraphic gastric emptying: clinical impression vs outcome

Abstract

<h3>Introduction</h3> In patients presenting with upper gastrointestinal (GI) symptoms, clinical impression of rapid or delayed gastric emptying (GE) may be misleading. This study was undertaken to determine the frequency of rapid/delayed GE compared to clinical presentation in patients referred for GE scintigraphy. <h3>Methods</h3> A retrospective review of 642 (234 males, 408 females, mean age 45 years old) consecutive GE studies was performed. Each patient received a standard solid meal containing two large eggs labelled with 12 MBq of 99mTc-tin colloid and a glass of water. Static imaging in upright position (anterior and posterior 60 s) every 15 min was performed for 150 min using a large field of view gamma camera fitted with a low energy collimator and a computer system. GE was classified as normal, rapid and delayed based on half-emptying time and percentage retained at 150 min. <h3>Results</h3> Seventy (11%) patients with suspected rapid and 572 (89%) with suspected delayed GE were studied. Normal, rapid and delayed GE, respectively, were observed in 11 (16%), 54 (77%) and 5 (7%) patients with the clinical suspicion of rapid GE and 178 (31%), 215 (37%) and 178 (31%) patients with suspected delay in GE. One patient with suspected delay had a biphasic GE pattern. Positive Predictive Value (PPV) of clinical suspicion for rapid GE was 77% while PPV of clinical suspicion for delayed GE was 31%. <h3>Conclusion</h3> Our experience demonstrates that clinical impression is often an unreliable predictor of the outcome of GE scintigraphy, especially in patients suspected of having a delayed GE. GE scintigraphy using solid egg meal is a very useful investigation in the management of patients presenting with complex upper GI symptoms.