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INTERPRETATION OF GASTRIC EMPTYING SCINTIGRAPHY FOR GASTROPARESIS: AN ASSESSMENT OF THE DELAYED EMPTYING AT 1, 2 OR 4 HOURS AND THEIR ASSOCIATION WITH PYLORIC DRAINAGE SURGERY OUTCOMES
Sven Eriksson
*1,3, Inanc Sarici
1,3, Marie-Lise Chrysostome
1, Mara Fryer
1, Ping Zheng
1, Shahin Ayazi
1,2,31Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Pittsburgh, PA; 3Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
Introduction:Gastroparesis is a gastric motility disorder characterized by symptoms suggestive of delayed gastric emptying without mechanical obstruction. Scintigraphy over 4 hours is the standard emptying test. Studies reporting 95
th percentiles in healthy controls suggest that ?90% retention at 1 hour, ?60% at 2 hours, and ?10% at 4 hours are consistent with gastroparesis. While the 2-hour and 4-hour thresholds are commonly used for diagnosis, there is limited data on their associations with outcomes after pyloric drainage surgery (pyloroplasty or per-oral pyloromyotomy). The aim of this study was to evaluate the gastric emptying scintigraphy results at 1, 2 and 4 hours for association with outcome after pyloric drainage surgery.
Methods:
Patients with symptoms suggestive of gastroparesis were evaluated with gastric emptying scintigraphy prior to pyloric drainage surgery. Patients completed the gastroparesis cardinal symptom index (GSCI) before and after surgery. Two favorable outcomes were evaluated: ‘GSCI score <3.5 or ?1 point improvement’ and ‘resolution of predominant gastroparesis symptoms’. Delayed emptying on scintigraphy was defined as a retention ?90% at 1 hour, ?60% at 2 hours or ?10% at 4 hours. Probabilities of favorable outcome based on these three definitions of delay gastric emptying were evaluated and compared.
Results:A total of 253 patients (83.6% female) underwent gastric emptying scintigraphy before pyloric drainage surgery, with a median (IQR) age of 51.0 (40-63), BMI of 27.6 (24-33). Gastroparesis etiology was 62.1% idiopathic, 21.0% diabetic and 17.0% postsurgical. At a mean (SD) of 8.54 (9) months after surgery 78.6% achieved a GCSI score <3.5 or ?1 point improvement and 76.3% achieved resolution of their predominant symptoms.
Favorable GCSI outcome for delayed at 1 hour was 71.7%, at 2 hours it was 76.9% and at 4 hours it was 80.3%. However, only delay at 4 hours was associated favorable outcome; delay at 1 or 2 hours was not (
Table).
Predominant symptom resolution for delayed at 1 hour was 72.7%, at 2 hours it was 75.2%, and at 4-hours it was 77.1%. Delay at 4 hours was the only factor associated with resolution of symptoms.
Conclusion:Despite the common use of delayed emptying at 2 hours or 4 hours to diagnose gastroparesis, only delay at 4 hours was associated with favorable outcome should be considered in patient selection for pyloric drainage surgery. Delayed emptying in the first two hours has no association with outcome. We recommend that early delay not be used for patient selection. However, even delay at 4 hours was not significant, underscoring the need for better diagnostic modalities.
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