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Effect of Early Emptying on Quantitation and Interpretation of Liquid Gastric Emptying Studies of Infants and Young Children

Division of Nuclear Medicine, Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: Leonard P. Connolly, MD, Division of Nuclear Medicine, Children's Hospital, 300 Longwood Ave., Boston, MA.

ABSTRACT

This study assesses the effect of emptying that occurs during feeding on quantitation and interpretation of liquid gastric emptying studies of infants and young children. Methods: Forty-nine ^99mTc-sulfur colloid liquid gastric emptying studies of 44 children (22 boys, 22 girls; mean age, 20 mo; age range, 2–46 mo) fed orally or by gastrostomy tubes were evaluated. Gastric residuals quantitated by 2 commonly used methods, the first of which does not account for early emptying and the second of which does, were compared. With the first method, residual relative to activity in the stomach at the start of imaging (R_g) was quantified by comparing activity in a region of interest (ROI) drawn about the stomach on the final image to activity in an ROI drawn about only the stomach at the start of imaging. With the second method, residual relative to total dose (R_t) was quantified by comparing activity in the same final ROI to activity in an ROI that included stomach and small bowel at the start of imaging. Studies were interpreted independently for R_g and R_t considering a value >70% as evidence of delayed emptying. Results: R_t was lower than R_g by 15%–16% for the entire population, for patients fed orally, and for patients fed by gastrostomy tube. These differences reached statistical significance (P < 0.0001). In 31 of 49 studies, R_t was lower than R_g by a 10%. In 8 studies, emptying classified as delayed on the basis of R_g was classified as nondelayed on the basis of R_t. Clinical decisions based on R_t did not require later management changes that would have indicated that treatment of gastric dysmotility had been postponed in any patient. Conclusion: Emptying that occurs during feeding should be factored into quantitation of liquid gastric emptying in infants and young children. Not recognizing and accounting for early emptying results in overestimated gastric residuals and can lead to classification of emptying as delayed in children whose residuals of the total administered dose are within a recognized range of normal.

Key Words: gastric emptying • children