Delayed gastric emptying - grade 4 (very severe)

Case contributed by Justin G Peacock


Patient reporting early satiety, nausea, vomiting, and bloating.

Patient Data

Age: 50 years
Gender: Female
Nuclear medicine

Gastric emptying study demonstrating Tc-99m sulfur colloid imaging with quantification after consumption of a standard meal. An initial, pre-eating image was obtained due to recent hepatobiliary scan, demonstrating radiotracer in large bowel. After eating, 0 minute, 30 minute, 1 hour, 2 hour, and 4 hour anterior and posterior images were obtained. Counts were quantified in the table and a time analysis curve was plotted against standard values.

The percent radiotracer retention was 100% at 0 minutes, 76% at 30 minutes, 74% at 1 hour, 61% at 2 hours, and 53% at 4 hours. Findings are consistent with severely delayed gastric emptying.

Case Discussion

Key learning points:

  • The standard protocol for gastric emptying is critical for standardization across different institutions and different points of time.
  • The most sensitive time point for diagnosing delayed gastric emptying is the 4 hour time point (>10% retention).
  • Delayed gastric emptying grades include
    • Grade 1 (mild): 11-20% retention
    • Grade 2 (moderate): 21-35% retention
    • Grade 3 (severe): 36-50% retention
    • Grade 4 (very severe): >50% retention
  • Delayed gastric emptying is commonly found in diabetics, post-surgery, post-viral infection, and idiopathically.

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