Abstract
1207
Introduction: Gastric emptying scintigraphy plays a vital role in the evaluation and management of gastric dysmotility, including the assessment for gastroparesis, nausea and vomiting. It is one of the most common nuclear medicine studies performed. Since gastric emptying dynamics is dependent on several factors, extensive work has been done to standardize acquisition parameters of this exam. In particular, a recommended standardized meal has been established in the United States, consisting of 2 slices of toasted white bread, 30g of jelly,118ml of liquid egg white and 120mL of water (1). Previously, a multicenter investigation established a range of normal reference values for gastric emptying using the complete standard meal in adults. However, in the clinical setting, it is not infrequent that the patient is unable to eat the complete meal. We previously showed that the partial ingestion of the standard meal can be assessed in with the adult criteria in the pediatric population (2). To date, no clinical guidance is in place to guide interpretation of such studies in the adults. The purpose of this study is thus to determine the performance of gastric emptying retention values defined using the complete standard meal for use with partially ingested standard meals in the adult population.
Methods: This IRB-exempt retrospective study analyzed adult (18 years and above) gastric emptying studies performed (n = 681) in the nuclear medicine department of a large academic medical center. The standard gastric emptying scintigraphy protocol was performed for all patients, with gastric retention values calculated at 1, 2, 3, and 4 h (as necessary) based on acquired images for all performed studies. Patients were identified to have normal or delayed gastric emptying based on the adult criterion of ≤10% emptying by 4 hours. Within these cohorts, the gastric retention values at all time points were compared between patients ingesting the complete standard meal and partial standard meals, segregated into 4 cohorts (<50% and ≥50% or <75% and ≥75% ingestion of the complete standard meal). Variations in gastric emptying due to differences in age ranges and sex were also assessed. The Kruskal-Wallis and Mann-Whitney non-parametric tests were performed for multiple comparisons where appropriate and p < 0.05 was deemed statistically significant.
Results: Of the 681 total patients, 419 subjects ate the complete standard meal (n = 318 with normal emptying and n = 101 delayed emptying). 262 subjects ate partial meals (n = 183 normal emptying and n = 79 delayed emptying). The gastric retention values for normal and delayed cohorts across different meal types are shown in Figure 1. .For normal subjects, there were significant differences in gastric retention at 1 and 2 h post ingestion between the complete meals and ingestion of <75% of the complete meal, but these values remained well above the 10% threshold criteria. No significant differences were noted at other time points. No significant differences in gastric retention values were noted across all meal types and time points were noted for delayed subjects. These findings were not significantly different across multiple age ranges and between sexes.
Conclusions: Our preliminary results suggest that the standard adult criteria for gastric emptying scintigraphy can be applied for partially ingested standard meals up to 75% of the complete meal. Further studies will be performed to ascertain this finding at multiple institutions and across patient subsets. Figures: Percentage gastric retention at 1, 2, 3 and 4hr for complete and partial meals (≥75, <75, ≥50 and <50) for normal (a) and abnormal/delayed studies (b). Whiskers denote 5% and 95% percentile values. Boxes denote 25%, 50%, and 75% values. Comparisons between meals for normal and delayed retention were performed with the Kruskal-Wallis test (*P≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001, and ****P ≤ 0.0001).
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