Introduction 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.
Methods 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 s) every 15 min 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.
Results Seventy (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%.
Conclusion 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.
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