Gastric accommodation measurements by single photon emission computed tomography and two‐dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms

Abstract

Objective To compare estimates of gastric accommodation (GA) with single photon emission computed tomography (SPECT) to measurements based on intragastric meal distribution immediately post‐meal ingestion (IMD0). Methods We evaluated 108 diabetics with upper gastrointestinal (UGI) symptoms who had undergone gastric emptying of solids (GE) by scintigraphy and GA measurements by SPECT. Immediately after ingestion of a 99mTc‐labeled egg meal (time 0), we estimated IMD0 as radioactive counts or area of the proximal half of the stomach on two‐dimensional images. Gastric volume (GV) during fasting and after 300 mL Ensure® was measured by SPECT to quantify accommodation volume (AV) or postprandial to fasting volume ratio (GVR). From the measured proximal gastric area, we estimated the volume of proximal stomach (4/3 × π × r3). We performed regression analyses to assess relationships between IMD0 and GA (AV) and GVR. Results There was a significant correlation between area and radioactivity counts in the proximal stomach (r = 0.67, P < 0.001); however, there was considerable interpersonal variation [bias 0.20 (95% CI −0.07, 0.47)]. There were no significant correlations between total GV or AV or VR by SPECT and measurements using IMD0: proximal gastric counts, area, and estimated volume as continuous variables of dichotomized patient groups, based on published cutoff values. There were no significant differences in total gastric area or the IMD0 parameters (% area or % radioactive counts) between those with and without UGI symptoms except for fullness and satiety. Conclusions Intragastric meal distribution immediately post‐meal ingestion is not significantly correlated with GA measurement by SPECT.

Gastric function in diabetic gastroparesis assessed by ultrasound and scintigraphy

“…Perlas et al 24 described gastric emptying assessment by ultrasound of the antrum, body, and fundus of the stomach, but were unable to visualize the fundus adequately to evaluate gastric emptying. Orthey and co‐workers presented a new method using enhanced gastric emptying scintigraphy to assess intragastric meal distribution, thus studying both gastric accommodation and proximal gastric emptying on healthy subjects in the same protocol, 26 but the method still needs more validation before being ready for clinical use 27 . In a study using scintigraphy by Edholm et al 28 on healthy subjects, the gastric emptying process was divided into a proximal and a distal part, and they studied the effects of incretin hormones.…”

“…Orthey and co-workers presented a new method using enhanced gastric emptying scintigraphy to assess intragastric meal distribution, thus studying both gastric accommodation and proximal gastric emptying on healthy subjects in the same protocol, 26 but the method still needs more validation before being ready for clinical use. 27 In a study using scintigraphy by Edholm et al 28 on healthy subjects, the gastric emptying process was divided into a proximal and a distal part, and they studied the effects of incretin hormones. They found that a low dose of glucose-dependent insulinotropic polypeptide (GIP) increased proximal emptying rate and decreased distal emptying rate, while a higher dose increased gastric emptying rate both proximally and distally.…”

Clinical trial: a single‐centre, randomised, controlled trial of tradipitant on satiation, gastric functions, and serum drug levels in healthy volunteers

“…In addition, immediately after ingestion of the meal, we estimated intragastric meal distribution as radioactive counts or area of the proximal half of the stomach on the two‐dimensional images. This has been proposed as an alternative assessment of gastric fundus accommodation, 13 though the method was not as accurate as three‐dimensional imaging using SPECT 14 as described below.…”

Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies

“…This suggests these measures may be assessing different aspects of gastric motor function and further validation of intragastric meal distribution scintigraphy technique as a measure of gastric accommodation is needed. 30…”