Gastric Emptying Scintigraphy Research Articles

Gastric emptying scintigraphy results in children are affected by age, anthropometric factors, and study duration.

A standardized 4-h adult-based gastric emptying scintigraphy (GES) protocol is increasingly being used in children to evaluate for gastroparesis. We sought to determine the effect of age, anthropometrics, and study duration on GES results using this protocol in children. Retrospective review of children who underwent a 4-h solid-meal GES study at a tertiary care center. GES results and anthropometric data (e.g., weight, stature, body surface area [BSA]) were systematically captured. Of 216 children, 188 (87%) were able to complete the study meal. Children unable to complete the meal were younger and smaller. In multivariate analysis, only increasing BSA was identified as being positively associated with ability to complete the meal (odds ratio: 19.7; p < 0.001). Of those completing the meal, 48 (26%) had delayed emptying (4-h retention value >10%). These children were significantly younger and smaller than those with normal emptying. In multivariate analysis of those completing the meal, only increasing BSA (odds ratio: 0.26; p = 0.006) was identified as being negatively associated with delayed emptying. There was a progressive increase in the positive predictive value for identification of delayed gastric emptying as the duration of the study increased (0.25, 0.60, and 0.71 at 1, 2, and 3 h, respectively) using the 4-hr value as a comparator. Young children have more difficulty completing the GES meal. Childhood gastric retention is affected by age and anthropometric factors, primarily BSA. The standardized 4-h GES protocol may need to take these factors into account in children.

Outpatient vs. Inpatient Gastric Emptying Studies: Does Admission Status Influence Findings?

Objectives: Gastric emptying studies are performed in both outpatient and inpatient settings. Although there is no data on the prevalence of positive and negative testing between inpatient and outpatient studies, some feel inpatient testing is inappropriate secondary to potential false positives. We aim to identify the incidence and determinants of abnormal studies for inpatient versus outpatient gastric emptying studies. Methods: A retrospective chart review of scintigraphic gastric emptying studies was performed between June 1, 2012 and April 11, 2014. Demographics, clinical information, and procedure details were collected. Descriptive statistics were used to report findings with categorical variables analyzed using Pearson Chi-Square test and continuous variables analyzed with independent samples t-test. All statistical analyses were performed using IBM SPSS Statistics version 21.0 software. Results: 107 GE studies were reviewed (34 inpatient, 73 outpatient). Six incomplete studies were excluded. Mean patient age was 51 years (64% female, 60% Caucasian). There were more women than men in the outpatient population (p=0.04). The inpatient studies had a higher percentage of African Americans while the outpatient studies were mostly Caucasian (p=0.002). There were no other demographic differences between the inpatient and outpatient groups. The most common indication for testing was nausea and/or vomiting (44%). 42 (22 inpatient, 20 outpatient) tests were positive and 59 (8 inpatient, 51 outpatient) were negative for impaired gastric emptying. Inpatient GE testing was abnormal 73% of the time, while outpatient GE testing was abnormal 28% of the time (p<0.01). Review of inpatient GE studies revealed 97% patients received a medication known to alter gastric motility and 67% received opioid narcotics within 72 hours of testing. Patients with diabetes were 2.28 times more likely to have a positive test than patients without diabetes. Half of the abnormal tests were found in patients with diabetes. Conclusions: Abnormal gastric emptying studies are more commonly found in inpatient studies. A majority of inpatient studies are performed on patients who have received medications known to delay gastric motility and may be at an increased risk for false positives.

A gluten-free vegan meal for gastric emptying scintigraphy: establishment of reference values and its utilization in the evaluation of diabetic gastroparesis.

The aim of this study was to describe the preparation of radiolabeled idli (savory cake) meal for use as an alternate to the egg white sandwich (EWS) meal in gastric emptying scintigraphy (GES). Furthermore, the aim of this study was to establish normal emptying rates for this meal and present our experience in using it in the evaluation of diabetic gastroparesis. The meal was prepared using a universally available packaged mix labeled with 1 mCi 99mTc sulfur colloid, and the stability of labeling was tested up to 4 hours in simulated gastric fluid. One hundred thirteen healthy volunteers (aged 20-78 years; 54 women, 59 men) underwent GES study using the idli meal. Gastric retention at one-half, 1, 2, and 4 hours after ingestion of the meal was estimated, and the normal limits were set using the fifth and 95th percentile values at each period. Having established its normal emptying rates, the idli meal was further used to evaluate 70 patients suspected with diabetic gastroparesis. The idli meal, with a calorific value ≈282 kcal, has a relatively higher fat content (8% of total mass) than EWS. More than 96% of 99mTc sulfur colloid remained bound to the meal after 4 hours suspension in simulated gastric fluid. Gastric retention greater than 30% and greater than 6% at 2 hours and 4 hours, respectively, indicated delayed gastric emptying, whereas retention less than 30% at 1 hour suggested rapid emptying. Among patients suspected with diabetic gastroparesis, delayed gastric emptying was identified in 76%, and rapid emptying was seen in 4.2%. Radiolabeled idli meal is a good alternative to EWS meal for routine GES, especially among patients with specific dietary restrictions.

Normal values and symptom correlation of a simplified oatmeal-based gastric emptying study in the Chinese population.

Instant oatmeal has been proposed as a good alternative to the standardized low-fat egg white test meal for gastric emptying studies. We aim to establish normal values of oatmeal-based gastric emptying scintigraphy and test its correlation with gastroparesis symptoms in the Chinese population. This study prospectively enrolled 60 healthy volunteers, 30 functional dyspepsia and 30 diabetes patients with gastroparesis symptoms. All participants were evaluated using the Gastroparesis Cardinal Symptom Index. Each participant ingested instant oatmeal mixed with 1 mCi of (99m) Tc diethylenetriaminepentacetic acid, and serial imaging was immediately acquired for 3 h in the supine position using a left anterior oblique projection. Time-activity curves were generated and quantitative parameters were determined. Normal values were established from healthy volunteers and further applied in the symptomatic patients. All participants finished the test meal and tolerated the procedure well. All gastric emptying parameters were not significantly affected by age or gender. Values above the 95th percentile of T1/2 , gastric retention at 1, 2, and 3 h (85 min, 65%, 28%, and 8%, respectively) were indicative of delayed gastric emptying. Values below the 5th percentile of gastric retention at 0.5 and 1 h (40% and 15%, respectively) were indicative of rapid gastric emptying. The lower gastric retention limit at 0.5 and 1 h were 40% and 15%, respectively. Four (13.3%) diabetes and four (13.3%) functional dyspepsia patients had delayed emptying while three diabetes patients (10%) had rapid emptying. Gastric emptying parameters correlated best with vomiting (r = 0.621) and nausea (r = 0.566) in diabetes patients. We established normal values of oatmeal-based gastric emptying scintigraphy and observed good correlation with cardinal gastroparesis symptoms in the Chinese population.

Acute Gastric Dysfunction After Catheter Ablation of Atrial Fibrillation: Presidential Poster

Introduction: Gastroparesis is a chronic disorder characterized by slow gastric emptying in the absence of mechanical obstruction. Rarely, acute cases of gastroparesis can present as an extracardiac complication caused by vagus nerve injury following radiofrequency ablation for the treatment of refractory atrial fibrillation. Here, we report a case of acute delayed gastric empting as a consequence of percutaneous catheter ablation of atrial fibrillation. Case Report: A 47-year-old female underwent catheter ablation for drug refractory atrial fibrillation. No complications were detected during procedure and the patient was discharged after 24 hours. Seven days later, the patient was seen in the emergency department with symptoms of worsening fullness and abdominal distention. On admission, the patient denied any nausea, vomiting, and/or abdominal pain. Abdominal exam showed a non-tender but distended abdomen, bowel sounds were markedly decreased, and positive succussion splash during auscultation. The hematological profile, blood sugar, electrolytes, renal function, and LFTs were otherwise unremarkable. A CT of the abdomen showed severe distention of the gastric lumen containing heterogeneous congested material. However, there was not evidence of luminal obstruction, as contrast material was observed in the mid ileum. A scintigraphic 4-hour gastric emptying test (GET) was performed. Thirty-two percent of the meal was retained at the end of 4 hours (Normal <10% retention at the end of 4 hours). Diagnosis of gastroparesis was made, a nasogastric tube was inserted, and the patient was started on metoclopramide HCL 20 mg IV every 8 hours. On the following day, the patient became less symptomatic with a significant reduction in abdominal distention. On the third day, metoclopramide was switched to 10 mg PO before meals and she was able to tolerate a liquid diet. The patient made an excellent recovery and was discharged with a taper (4 weeks) course of metoclopramide. The patient did not complain of any gastrointestinal symptoms during the follow-up 2 weeks after hospital discharge. Discussion: Catheter ablation has improved the treatment paradigm of atrial fibrillation, but it may be associated with significant gastrointestinal complications. The onset of symptoms varies, and can occur immediately post-procedure and up to 4 days later. Management is no different to that of other causes of acute gastric emptying delay, and it usually entails a combination of strategies. As electrophysiologists continue to use this procedure in the management of atrial fibrillation, such cases will continue to arise. It is our intent to make gastroenterologists aware of this rare complication, to facilitate early initial diagnosis and management.

Normal Solid Gastric Emptying Values Measured by Scintigraphy Using Asian-style Meal:A Multicenter Study in Healthy Volunteers.

Background/AimsTo report gastric emptying scintigraphy, normal values should be established for a specific protocol. The aim of this study was to provide normal gastric emptying values and determine factors affecting gastric emptying using Asian rice-based meal in healthy volunteers.MethodsOne hundred and ninety-two healthy volunteers were included at 7 tertiary care centers across Thailand. Gastric emptying scintigraphy was acquired in 45 degree left anterior oblique view immediately after ingestion of a 267 kcal steamed-rice with technetium-99m labeled-microwaved egg meal with 100 mL water for up to 4 hours.ResultsOne hundred and eighty-nine volunteers (99 females, age 43 ± 14 years) completed the study. The medians (5–95th percentiles) of lag time, gastric emptying half time (GE T1/2) and percent gastric retentions at 2 and 4 hours for all volunteers were 18.6 (0.5–39.1) minutes, 68.7 (45.1–107.8) minutes, 16.3% (2.7–49.8%) and 1.1% (0.2–8.8%), respectively. Female volunteers had significantly slower gastric emptying compared to male (GE T1/2, 74 [48–115] minutes vs. 63 (41–96) minutes; P < 0.05). Female volunteers who were in luteal phase of menstrual cycle had significantly slower gastric emptying compared to those in follicular phase or menopausal status (GE T1/2, 85 [66–102] mintes vs. 69 [50–120] minutes or 72 [47–109] minutes, P < 0.05). All of smoking volunteers were male. Smoker male volunteers had significantly faster gastric emptying compared to non-smoker males (GE T1/2, 56 [44–80] minutes vs. 67 [44–100] minutes, P < 0.05). Age, body mass index and alcohol consumption habits did not affect gastric emptying values.ConclusionsA steamed-rice with microwaved egg meal was well tolerated by healthy volunteers. Gender, menstrual status and smoking status were found to affect solid gastric emptying.

PTU-146 The Trinity Of Gastric Emptying Scintigraphy, 13c Acetate Gastric Emptying Breath Testing, And Real Time Gastric Ultrasonography Indicates High Prevalence Of Gastric Motor Dysfunction In Functional Dyspepsia

IntroductionGastric motor physiology can be assessed by gastric emptying scintigraphy (GES), 13C breath testing (GEBT) and real time gastric ultrasound (GUS). The aim of this study was to evaluate how...

Tu1847 The Trinity of Gastric Emptying Scintigraphy, 13C Acetate Gastric Emptying Breath Testing, and Real Time Gastric Ultrasonography Indicates High Prevalence of Gastric Motor Dysfunction in Functional Dyspepsia

Introduction Gastric motor physiology can be assessed by gastric emptying scintigraphy (GES), 13 C breath testing (GEBT) and real time gastric ultrasound (GUS). The aim of this study was to evaluate how commonly these tests are abnormal in patients with functional dyspepsia (FD). Methods Twenty-seven patients fulfilling the Rome III criteria for FD were enrolled in the study. All patients had a normal upper GI endoscopy and underwent standard GES using 131 I-technetium labelled mashed potato. On a separate day, these patients underwent a combined liquid GEBT (four hour breath test protocol using 170 ml chocolate Ensure liquid substrate + 50 mg 13 C-acetate) and GUS (calculating antral area at the time of ingestion and 15 min after ingestion of the GEBT liquid test meal). Results Eight of the 27 patients had one abnormal test, six had two and in five, all three tests were abnormal. In fifteen of the 27 patients with a normal GES (56%), eight had normal GEBT and GUS studies. Of the remaining seven patients, four had a normal GEBT and an abnormal GUS, two had normal GUS with an abnormal GEBT, and in one, both the GEBT and GUS were abnormal. GES was delayed in ten of the 27 patients (37%). In four of these, both GEBT and GUS were abnormal, three had delayed gastric emptying on GEBT with a normal GUS, two had delayed gastric emptying on GUS with normal GEBT, and in one patient, both GUS and GEBT were normal. GES was abnormally rapid in two patients (7%). In one patient, both GEBT and GUS indicated rapid gastric emptying and in the other, GUS revealed rapid gastric emptying with a normal GEBT. Assuming GES as the gold standard for diagnosing abnormal gastric emptying, GUS has a sensitivity and specificity for detecting a motor disorder of 66% and GEBT has a sensitivity of 66% and a specificity of 80%. Conclusion In this group of FD patients, 70% had at least one abnormal test of gastric motor function. Whilst GES is regarded as the gold standard test, in seven patients with normal GES, the GEBT, GUS, or both, were abnormal. This discrepancy might reflect the day-to-day variability of gastric motor function testing or that each investigation measures a different component of gastric motor physiology. We conclude that in FD, adding GEBT and GUS to GES substantially increases the positive diagnostic yield and the heterogeneous patterns might indicate a variety of FD subtypes. Disclosure of Interest None Declared.

Mo1295 Symptoms Following Meal Ingestion During Gastric Emptying Scintigraphy in Patients With Gastroparesis

Mo1295 Symptoms Following Meal Ingestion During Gastric Emptying Scintigraphy in Patients With Gastroparesis

Mo1316 Two Hour Gastric Emptying Radionuclide Scintigraphy is Associated With False Diagnosis of Gastroparesis in Children

Introduction: Gastroparesis is a rare motor and sensory disorder of the stomach resulting in delayed gastric emptying in the absence of mechanical obstruction. Symptoms include nausea, vomiting, early satiety, bloating, abdominal pain, and weight loss. There is a paucity of data about the prevalence and etiology of gastroparesis in children, but the most common etiologies are post-viral, idiopathic and autonomic dysfunction disorders. Four hour radionuclide scintigraphic gastric emptying (GE) study is the recommended diagnostic study for gastroparesis. Many centers perform only a 2 hour GE study. There have been no comparison studies between these twomethods in pediatric patients. Methods:We conducted a retrospective review of the Mayo Clinic electronic data between April 2005 and June 2013. All children age (0-18) years diagnosed with gastroparesis, who underwent a 2 hour GE study, followed by 4 hour GE study were included. Children with history of gastric surgery (including gastric neurostimulator devices), diabetes, or on prokinetic medications were excluded. GE study was considered abnormal when GE was less than 7% at 1 hour, 31% at 2 hours and 81% at 4 hours. All demographic, symptoms and GE test results were recorded. This study was approved by the Mayo Clinic IRB. Results: A total 13 children (7 females, average age of 12 years) were identified. The most common reported symptoms at the time of both studies were abdominal pain (63%), nausea/ vomiting (38%), and bloating/ abdominal distention (16%). Many patients had multiple symptoms. Eighty five percent (n= 11) patients were diagnosed with gastroparesis using the 2 hour GE study. Out of 11 patients only 2 (18%) were confirmed with gastroparesis on the subsequent 4 hour GE study. Median time between the two studies was 6 months. None of the patients who had normal 2 hour study had an abnormal 4 hour study. Discussion: All patients who were diagnosed with gastroparesis by the 2 hours GE study continued to have symptoms despite trying different medications and diet modifications. Patients discontinued any prokinetic medications before repeating a 4 hour GE study. Most of the patients (85%) had a normal 4 hour GE study, despite persistence of their symptoms. These patients could have had GI symptoms due to a different etiology such as functional or other motility disorders (impaired accommodation). The improved GE results could be due to regression toward the mean, or true improvement in the gastric emptying function during the time elapsed between the two studies. Conclusion: The 2 hour radionuclide scintigraphic GE test is unreliable, and can result in false diagnosis of gastroparesis in children. Four hour GE radionuclide scintigraphy testing should be the standard practice.

Relationship of Gastrointestinal Symptoms and Psychosocial Distress to Gastric Retention in Children

To determine whether gastrointestinal (GI) symptoms (abdominal pain, nonpain GI symptoms, nausea) and/or psychosocial distress differ between children with/without gastroparesis and whether the severity of GI symptoms and/or psychosocial distress is related to the degree of gastroparesis. Children aged 7-18 years (N = 100; 63 female patients) undergoing a 4-hour gastric emptying scintigraphy study completed questionnaires evaluating GI symptoms, anxiety, and somatization for this prospective study. Spearman correlation, Mann-Whitney, t-test, and χ(2) tests were used as appropriate for statistical analysis. Children with gastroparesis (n = 25) were younger than those with normal emptying (12.6 ± 3.5 vs 14.3 ± 2.6 years, P = .01). Because questionnaire responses from 7- to 10-year-old children were inconsistent, only patient-reported symptoms from 11- to 18-year-olds were used. Within this older group (n = 83), children with gastroparesis (n = 17) did not differ from children with normal emptying in severity of GI symptoms or psychosocial distress. In children with gastroparesis, gastric retention at 4 hours was related inversely to vomiting (r = -0.506, P = .038), nausea (r = -0.536, P = .019), difficulty finishing a meal (r = -0.582, P = .014), and Children's Somatization Inventory score (r = -0.544, P = .024) and positively correlated with frequency of waking from sleep with symptoms (r = 0.551, P = .022). The severity of GI symptoms and psychosocial distress do not differ between children with/without gastroparesis who are undergoing gastric emptying scintigraphy. In those with gastroparesis, gastric retention appears to be inversely related to dyspeptic symptoms and somatization and positively related to waking from sleep with symptoms.

Decreased Relative Diagnostic Yield of Esophagogastroduodenoscopy in Children With Gastroparesis

Esophagogastroduodenoscopy (EGD) and gastric emptying scintigraphy (GES) are commonly performed in the evaluation of children with upper gastrointestinal symptoms. It has been presumed, but not clarified, that gastroparesis increases the likelihood of identifying abnormalities on EGD. We sought to determine whether the presence of gastroparesis influenced the diagnostic yield of EGD in children. We conducted a retrospective chart review of children who underwent both an EGD and GES within 3 months of each other for evaluation of upper gastrointestinal symptoms (eg, abdominal pain). Clinical history (symptoms, comorbidities, medications, and surgical procedures), GES results, and EGD histology reports were captured. A total of 125 children (46% female) were included, of whom, 70 (56%) had gastroparesis. Thirty-three (26%) children had liquid meal GES (1.2 ± 1.1 y of age, mean ± SD) and 92 (64%) had solid meal GES (12.4 ± 3.6 y of age). There was an overall trend toward a decreased frequency of biopsy abnormalities in those with gastroparesis (P=0.09). Those with gastroparesis identified through liquid meal GES were less likely to have reflux esophagitis on biopsy (P=0.002). Those with gastroparesis identified on solid meal GES were less likely to have gastritis (P=0.04). Symptoms, comorbidities, or medications were not predictive of GES or EGD results. Children with gastroparesis may be less likely to have biopsy abnormalities identified on EGD in comparison to those without gastroparesis. Further prospective, larger, and multicenter studies are needed to validate our findings.

Vomiting and dysphagia predict delayed gastric emptying in diabetic and nondiabetic subjects.

Background. Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined. Methods. During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age 60.2 ± 15.6 years). Subjects were grouped according to gastric half-emptying times (gastric T 1/2). Demographic and clinical data were extracted from electronic medical records or by a phone interview. Key Results. Gastric emptying half-times were normal (gastric T 1/2 0–99 min) in 101 patients, abnormal (gastric T 1/2 100–299 min) in 67 patients, and grossly abnormal (gastric T 1/2 ≥ 300 min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptying. Diabetes was associated with grossly abnormal gastric T 1/2. Idiopathic gastroparesis was associated with a younger age at GES. No correlation was observed between gastric T 1/2 values and gender, smoking, H. pylori infection, HBA1C, or microvascular complication of diabetes. Conclusions Inferences. Vomiting and dysphagia are predictive of delayed gastric emptying in both diabetic and nondiabetic subjects. Diabetes is associated with more severe gastroparesis.

A Rare Complication of Cryoballoon: Gastroparesis

Despite higher frequency of complications secondary to collateral nerve damage after radiofrequency catheter ablation of atrial fibrillation (AF), in the cryoballoon technique gastroparesis has not been clearly revealed yet. We presented a patient who developed severe gastroparesis during cryoballoon ablation. A -64 -year-old female patient underwent pulmonary vein isolation (PVI) of drug resistant symptomatic paroxysmal AF with cryoballoon. PVI was achieved in 3 pulmonary veins with cryoballoon using standard tecnique. During isolation of the right inferior pulmonary vein, the patient complained of stomach ache, bloating, and nausea. At the beginning, these complaints were thought to be related to gastric irritation due to heparin bolus, and the procedure was continued. Proton pump inhibitor was administered through intravenous route. However her complaints continued with increasing severity. Fluoroscopy revealed that stomach was completely full of air which indicates an episode of acute pyloric spasm or gastroparesis (Figure 1). Then nasogastric tube was placed, and IV metochlopramide was administered. At the end of 24 hours, her complaints regressed completely. Then her nasogastric tube was removed, and oral intake was initiated. She has been still asymptomatic after 6 months follow-up. The diagnosis of gastroparesis confirmed with gastric emptying scintigraphy. Although this procedural complication which can cause serious symptoms is not seen so frequently, it should be kept in mind in patients with similar complaints, and it should be considered in the management of the patients with similar complaints. We presented this case to emphasize the above mentioned important points.

Effects of Surgical Correction of Neuromuscular Scoliosis on Gastric Myoelectrical Activity, Emptying, and Upper Gastrointestinal Symptoms

Gastrointestinal complications are frequent after surgical correction of neuromuscular scoliosis, but the effects of scoliosis surgery on gastric function and upper gastrointestinal symptoms over the long term are unknown. Thirty-one children (16 spastic, 15 flaccid patients) who underwent surgical correction of neuromuscular scoliosis were included in a prospective follow-up study. Median (range) age at surgery was 14.9 (5-20) years and follow-up time 4.3 (2-8) years. Electrogastrography (n=28), gastric emptying scintigraphy (n=17), and structured upper gastrointestinal symptoms questionnaire (n=26) were evaluated before and after surgery. The results were related to patients' clinical state, type and extent of corrective spinal surgery, and gastrointestinal complications. The median main scoliosis curve of 81 degrees (51-129 degrees) was corrected to 25 degrees (1.0-85 degrees) after surgery. In electrogastrogram, power ratio increased from preoperative 1.4 (0.30-11) to postoperative 6.2 (1.2-26) in the spastic group (P=0.008), whereas in the flaccid group, power ratio remained unchanged at 2.2 (0.1-17). Patients with prolonged postoperative paralytic ileus had the most substantial increase in gastric power ratio (P=0.038). Correction of sagittal spinal balance correlated with increased postprandial normogastric activity after surgery (R=0.459; P=0.004). The gastric emptying results, upper gastrointestinal symptoms, and body mass index were not significantly altered after scoliosis surgery. Gastric myoelectrical power increased after surgical correction of spastic neuromuscular scoliosis and was associated with prolonged postoperative paralytic ileus. Correction of poor, stooped spinal balance improved gastric myoelectrical activity. The net effect of scoliosis surgery on gastric emptying, upper gastrointestinal symptoms, and clinical nutritional state was minimal.

Efficacy of Laparoscopic Pyloroplasty for the Treatment of Gastroparesis

The modest results of nonoperative modalities for the treatment of gastroparesis necessitate greater consideration of surgical therapies. However, the role of surgery is not well defined. The aim of this study is to present our experience with laparoscopic pyloroplasty as early treatment for gastroparesis. Fifty patients with refractory gastroparesis underwent laparoscopic pyloroplasty (hand-sewn Heineke-Mikulicz configuration) from 2006 to 2013 at our institution. Preoperative and postoperative symptom data, gastric emptying scintigraphy, and technical outcomes of the procedure were reviewed. A single-factor ANOVA was performed for the comparison of continuous variables. Results are reported as mean ± SD or median absolute deviation. Thirty-four of 50 (68%) patients had previous foregut procedures and/or cholecystectomy. Thirty-two of 50 (64%) patients underwent concomitant procedures (ie, paraesophageal hernia repair and gastrostomy takedown) along with the pyloroplasty. Operative time, including combined procedures, blood loss, and length of stay were 175 ± 56 minutes, 64 ± 50 mL, 2.5 ± 2.7 days, respectively. There were no conversions to open technique or intraoperative complications. There were no suture-line leaks. The readmission rate was 14%. All patients had symptom follow-up and 33 (66%) had postoperative gastric emptying scintigraphy. Postoperative symptom improvement was reported by 82% of the patients (p < 0.001). Median preoperative T1/2 was 180 ± 73 minutes and postoperative T1/2 was 60 ± 23 minutes (p < 0.001). Five patients (10%), who had normalized postoperative T1/2 times, required other gastric emptying procedures; distal gastrectomy (n = 2), duodenojejunostomy (n = 2), and gastric stimulator placement (n = 1). Laparoscopic pyloroplasty is an effective early-treatment modality for selected cases of gastroparesis, with substantial improvement in objective gastric emptying times and low morbidity. The laparoscopic approach does not preclude subsequent procedures when necessary.

Factors associated with delayed gastric emptying in patients with stent placement for malignant gastric outlet obstruction.

Background and study aims: Delayed gastric emptying (DGE) is an important factor in determining the clinical outcome in patients with stent placement for malignant gastric outlet obstruction but the factors associated with DGE remain unclear. The aim of this study was to investigate whether clinicopathologic data could be used to identify the factors for DGE in such patients. Patients and methods: A prospective, single-arm, observational clinical study was performed in a referral hospital in Japan. A total of 54 patients with stent placement for malignant gastric outlet obstruction were enrolled. A gastric emptying scintigraphy test was performed 1 week after stent placement. The relationship between DGE and clinicopathologic factors was investigated, and also the relationship between DGE and stent patency time, eating period (when the patient was able to maintain oral intake), and survival time. Results: A total of 38.9 % (21 /54) of patients had DGE. The following were identified as independent predictive factors of DGE: opioid use (odds ratio, 5.32; 95 % confidence interval [95 %CI], 1.07 – 26.41; p = 0.04), chemotherapy before stent placement (odds ratio, 8.03; 95 %CI, 1.85 – 34.95; p = 0.006), and smaller stent diameter (odds ratio, 13.59; 95 %CI, 1.72 – 107.41; p = 0.01). No relationship was found between DGE and the level of oral intake, stent patency time, eating period, and survival time. Conclusions: The factors associated with DGE after stent placement include those associated with the patient’s tumor as well as factors relating to their treatment, including stenting. The clinical and functional results after stent placement appear to be unrelated to the gastric emptying findings.

Effect of Intragastric Balloon on Gastric Emptying Time in Humans for Weight Control

This study evaluated the effect of fluid-filled intragastric balloon treatment on the scintigraphic gastric emptying times in humans for weight control. Ten obese patients were prospectively recruited in our study. Three participants followed a solid food diet, and 7 participants followed a liquid meal diet to evaluate their scintigraphic gastric emptying times before and 3 months after fluid-filled intragastric balloon treatment. The participants included 3 males and 7 females. The mean age, body mass index, and body weight before intragastric balloon treatment were 36.8 ± 9.16 years, 35.91 ± 8.86 kg/m(2), and 93.9 ± 24.09 kg, respectively. The mean body weight, body mass index, and body weight loss 3 months after the treatment were 80.2 ± 21.32 kg, 31.50 ± 8.90 kg/m(2), and 13.7 ± 6.60 kg, respectively. The solid gastric emptying times before and 3 months after intragastric balloon treatment were 114 ± 18.52 minutes and 375.33 ± 207.04 minutes, respectively. The liquid gastric emptying times before and after intragastric balloon treatment were 38.71 ± 15.91 minutes and 318.71 ± 168.07 minutes, respectively. Statistically significant differences were observed in the solid and liquid gastric emptying times before and 3 months after intragastric balloon treatment using the Wilcoxon t test (P = 0.027, P = 0.001). Significantly positive correlations were observed between body weight loss and solid and liquid gastric emptying times after intragastric balloon placement using the Spearman correlation (β = 1.0, P < 0.001; β = 0.95, P = 0.001). The solid and liquid scintigraphic gastric emptying half time is significantly longer after intragastric balloon treatment in humans. A significantly positive correlation between body weight loss and scintigraphic gastric emptying time was observed after intragastric balloon treatment. We can predict the effect of intragastric balloons on weight control through scintigraphic gastric emptying times after the treatment. The effect of intragastric balloons on weight loss may be reinforced by combining intragastric balloon treatment with medication that can reduce gastric motility.

Nausea Predicts Delayed Gastric Emptying in Children

To assess whether the gastroparesis cardinal symptom index (GCSI), or any individual symptom, is associated with delayed gastric emptying in children, and to assess understanding of symptoms associated with delayed gastric emptying. Fifty children (36 F), 5-18 years of age, undergoing gastric emptying scintigraphy (GES) at Lurie Children's Hospital in Chicago, Illinois, completed Likert-type GCSI and symptom comprehension questionnaires. Correlation of GES results (normal or abnormal) with questionnaire results using the Wilcoxon rank sum test. Seventy percent of subjects had a normal GES. Children reported understanding most terms of GCSI (average score 2.59, range 0-3). The GCSI was not associated with delayed gastric emptying. Nausea was associated with delayed gastric emptying only (numerical P = .04, word P = .02). Results were not altered when poorly understood terms were excluded. The GCSI is not associated with delayed gastric emptying in children. Lack of association does not seem to be related to lack of understanding. Nausea alone was the only symptom that showed an association with delayed gastric emptying on GES.

Value of Scintigraphy for Assessing Delayed Gastric Emptying After Pancreatic Surgery

Delayed gastric emptying (DGE) occurs frequently after pancreatic surgery. Recently a consensus definition of DGE was introduced, and this grading system is currently widely used. The aim of this study was to compare results of gastric emptying scintigraphy with the grade of DGE after pancreatic surgery. In 44 patients undergoing exploration for a pancreatic head or periampullary tumor, 28 pancreatoduodenectomies (PDs) and 16 double-bypass procedures were performed. All patients underwent preoperative and postoperative gastric emptying scintigraphy. We investigated whether the incidence of DGE was correlated with the results of gastric emptying scintigraphy. DGE occurred in 19 (43 %) patients. Clinically relevant DGE (grades B and C) prevailed in the PD group. Median postoperative residual activity at t = 2 h (%RA120) in these groups was 36 % (no DGE), 75 % (grade A), 93 % (grade B), and 95 % (grade C). DGE grade B or C was found in 7 of 10 patients with %RA120 of ≥94 % on postoperative day (POD) 7. Postoperative %RA120 on scintigraphy is positively associated with severity of DGE. Gastric emptying scintigraphy on POD 7 can predict the severity of DGE. When postoperative gastric emptying scintigraphy shows high residual radioactivity, the likelihood of further progression to grade B or C DGE is high and warrants investigation for underlying causes.