Using gastric emptying scintigraphy to evaluate antral contractions and duodenal bolus propagation

Abstract

Our aim was to investigate the feasibility of measuring antral contractions and duodenal bolus propagation (DBP) during dynamic antral contraction scintigraphy (DACS) as an assessment of antro-pyloro-duodenal coordination (APDC). Gastric emptying scintigraphy (GES) with DACS was performed with Tc-99m sulfur colloid (SC) using increasing doses of 74 MBq (2 mCi) for 10 subjects, 185 MBq (5 mCi) for 11, and 370 MBq (10 mCi) for 11. DACS was performed for 10 min after static images at 0, 30, 60, 120, 180, and 240 min in anterior and right anterior oblique (RAO) projections. Best projection and lowest dose of Tc-99m SC were assessed visually. DBP were quantified utilizing duodenal activity peaks from a region of interest in the first portion of the duodenum. DBP was better visualized in the RAO projection than anterior projection and using 185 MBq (5 mCi) and 370 MBq (10 mCi) compared with 74 MBq (2 mCi). DBP showed infrequent and irregular bolus transfers from the antrum to the duodenum. Antral activity peaks at 60 min averaged 2.91 ± 0.66 per minute and duodenum bolus peaks 0.36 ± 0.18 per minute (ratio 0.36/2.91 = 0.12). DBP activity peaks can be measured during GES with DACS but requires a 185-MBq (5 mCi) dose of Tc-99m SC radiolabeled test meal for adequate DBP signal detection and is better imaged in RAO than anterior projection. DBPs over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess APDC. NEW & NOTEWORTHY This study shows that duodenal bolus propagations after meal ingestion can be measured during gastric emptying scintigraphy using dynamic scintigraphy. Duodenal bolus propagation over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess antropyloroduodenal coordination in patients with unexplained symptoms of upper gastrointestinal dysmotility.

Automatic assessment of human gastric motility and emptying from dynamic 3D magnetic resonance imaging

“…In this study, we present a workaround by employing an automatic surface-based analysis of the luminal boundary motion in the stomach. The dominant frequency of gastric contraction measured with our automated method (ie, 3.09 ± 0.07 CPM) showed good correspondence to previously reported frequencies (also around 3CPM) measured with MRI, 19,41 scintigraphy, 42 manometry, 43 or electrogastrogram. 29,44 Uniquely, this surface-based representation provides a way for researchers and clinicians to visualize motility patterns of the entire stomach rather than just within a region of interest, and has the potential to normalize motility patterns across individuals through surface registration.…”

Gastric half emptying time (T½) for 4‐h gastric emptying scintigraphy simplifies reporting but reduces detection of gastroparesis

“…This study was reviewed and approved by the Temple University Institutional Review Board. General data collected for each subject included information collected for the GES test (demographics, medical, and surgical history, PAGI‐SYM and GCSI Questionnaires, Nuclear Medicine Patient Information Sheet) and technical aspects of the test (time taken for the patient to consume the meal, amount of the meal ingested, and times of the specific image acquisition) 10,11 …”

“…General data collected for each subject included information collected for the GES test (demographics, medical, and surgical history, PAGI-SYM and GCSI Questionnaires, Nuclear Medicine Patient Information Sheet) and technical aspects of the test (time taken for the patient to consume the meal, amount of the meal ingested, and times of the specific image acquisition). 10,11 In addition, a review of 31 GES values from a prior study of healthy volunteers who had undergone GES was compared to the study group of patients. 12…”

The Effect of Continuous Intake of Lactobacillus gasseri OLL2716 on Mild to Moderate Delayed Gastric Emptying: A Randomized Controlled Study

“…It is characterized by abnormalities in the rate of gastric emptying into the duodenum and involves gastrointestinal symptoms (including abdominal pain, diarrhea, borborygmi, nausea, and bloating) caused by indigestion due to rapid gastric emptying [26]. In recent years, it has been suggested that the severity of gastroparesis symptoms is associated with other factors, such as abnormal antropyloroduodenal coordination, rather than delayed gastric emptying [14,27]. The coordinated movement of the stomach and duodenum after a meal is important in terms of digestion and absorption.…”