Luke Ienari Sonoda MBBCh, PhD, Presenter: Nothing to Disclose

Mohamed Halim MRCP, Abstract Co-Author: Nothing to Disclose

Stephen Middleton MRCP, Abstract Co-Author: Nothing to Disclose

Kottekkattu K. Balan, Abstract Co-Author: Nothing to Disclose

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.

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 second) every 15 minutes 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.

70 (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%.

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.

GE scintigraphy is very useful in the evaluation of patients with various GI symptoms, especially those with symptoms of a delayed GE, where clinical impression is often misleading.

Sonoda, L, Halim, M, Middleton, S, Balan, K, Reliability of Presenting Symptoms in Predicting Outcome of Gastric Emptying Scintigraphy.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002083.html