PT  - JOURNAL ARTICLE
AU  - Thomas Ng
AU  - Niharika Putta
AU  - Laura Drubach
AU  - Neha Kwatra
AU  - Frederic Fahey
AU  - Samuel Nurko
AU  - Alejandrro Flores
AU  - Stephan Voss
TI  - How much do we need to eat? Assessment of partial standard meals for use in pediatric gastric emptying studies
DP  - 2020 May 01
TA  - Journal of Nuclear Medicine
PG  - 117--117
VI  - 61
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/61/supplement_1/117.short
4100  - http://jnm.snmjournals.org/content/61/supplement_1/117.full
SO  - J Nucl Med2020 May 01; 61
AB  - 117Introduction: The standardized meal for adult gastric motility scintigraphy in the US consists of two eggs, two pieces of toast with jelly, and 120mL of water. This meal and the associated defined standards of normal gastric retention values, as measured in adults, are also applied to the pediatric populations. However, a recent study suggests that less than one third of pediatric patients can consume the entire standard adult meal, with younger patients especially less able to do so. It is thus imperative to understand the utility of results obtained from studies derived from partially ingested meals. While it would be ideal to obtain normative values for each type of partial meal, this is not practical nor ethical. The goal of this study is to assess the applicability of the adult standard meal criterion of <10% meal retention by 4 hours post meal ingestion for partially consumed adult standard meals in the pediatric population. Methods: This retrospective study analyzed data from all patients (n = 1151) who underwent gastric motility scintigraphy studies between 9/2013 and 9/2019 at Boston Children’s Hospital. Patients who ate complete and partial standard adult meals were identified. Partial standard meals were stratified into sub-groups for further analysis: ≥75%/<75% and ≥50%/<50% ingestion of the complete meal (Table 1). The standard gastric emptying scintigraphy protocol was performed for all patients, with gastric retention values calculated at 1, 2, 3, and 4 h. Patients were additionally divided into normal and delayed gastric emptying based on the adult criterion of ≤10% emptying in 4 hours. Gastric retention values at all time points for each non-standard partial meal cohort were compared to those patients who ate 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 and p < 0.05 was deemed statistically significant. Results Of the 1151 total patients, 735 subjects ate the complete standard meal (n = 549 with normal emptying and n = 186 delayed emptying). 205 subjects ate partial meals (n = 165 normal emptying and n = 40 delayed emptying). Stratification into ≥75%/<75% meal completion and ≥50%/<50% meal completion resulted in the following subject split - ≥75% meal completion: n = 93 normal, n = 19 delayed; <75% meal completion: n = 72 normal, n = 21 delayed and for ≥50% meal completion: n = 148 normal, n = 35 delayed); <50% meal completion: n = 15 normal, n = 5 delayed, respectively. The median (95% upper reference limit) retention percentages for the complete standard meal were 72% (93%) at 1 h, 39% (65%) at 2 h, 15% (33%) at 3 h and 6% (10 %) at 4 h. The corresponding values for the ≥75% and ≥50% meal ingestion cohorts for 1-4 hours were 68% (89%), 31% (57.4%) 10% (26.6%), 5% (10 %) and 68% (89%), 32% (57%), 10% (28.7%), 5% (10%), respectively (Figure 1). While there were significant differences in gastric retention between complete and partially ingested meals for normal subjects at all percentages ingested, the 95% upper reference limit for gastric retention for the ≥50% meal ingestion cohort remained within 8 percentage points of the same reference limits seen in patients ingesting the complete meal. No significant differences in gastric retention values were noted in patients deemed to have delayed gastric emptying between those ingesting complete meals and partial meals up to ≥50%. No significant differences in gastric emptying for both normal and delayed patients were noted between sexes (Figure 2) and across age ranges (Figure 3). Conclusions: The current adult criterion for normal gastric motility, defined as <10% gastric retention by 4 hours post meal ingestion, can be applied to children who ingest as little as 50% of the standard adult meal. This was applicable across all age ranges examined and between both sexes. Further studies should be performed across institutions to confirm these findings.