Presentation
A 60-year-old man undergoes assessment for chronic bloating. Endoscopy was normal.
Patient Data
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Anterior and posterior planar images of the abdomen obtained at 0 minutes (immediately after meal ingestion), 30 minutes, 1-hour, 2-hours and 4-hours. Region-of-interest (ROI) delineates the stomach. The counts are measured and used to calculate the geometric mean and the percent retention at each time point.
At T=0 and 30 minutes, the radiolabeled meal appropriately localises to the fundus due to fundal accommodation. At later time points, the majority of the meal fails to transit distally and into the small bowel. 71% of the meal is retained in the stomach at 2-hours and 56% at 4-hours. These results are consistent with delayed gastric emptying and likely due to fundal dysfunction - failing to contract and provide a pressure gradient to migrate food towards the antrum.
Case Discussion
Gastric emptying scintigraphy is a physiologic means of evaluating gastric transit, providing both qualitative and quantitative data.
Delayed gastric emptying, as seen in this case, is defined as >60% retention at 2-hours and/or >10% retention at 4-hours. These values are based upon a standardised solid meal, patient preparation and imaging protocol established by a multidisciplinary panel of gastroenterologists and nuclear medicine physicians in 2008.
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