Article Figures & Data
Figures
- FIGURE 1.
Compliance with 14 individual protocol variables. Results demonstrate that laboratories did not adhere to GES guidelines for most variables (9/14) (n = 127).
- FIGURE 2.
Number of variables compliant with guidelines per laboratory. Very few laboratories were compliant with all 14 variables.
Tables
Category Variable Definition Patient preparation Medication withholding Instructions are given for withholding prokinetic agents (metoclopramide, domperidone, and erythromycin), opiates, anticholinergic/antispasmodic agents, atropine, nifedipine, progesterone, octreotide, theophylline, benzodiazepine, and phentolamine. Withholding time Protocol clearly states that all of the above medications should be withheld for 2 d. Blood glucose Instructions are given to test that serum glucose level is <200 mg/dL before the study. Blood glucose recording Instructions are given to record blood glucose level and include in final report. Meal Consensus meal Meal is properly prepared using 118 mL (4 oz) of liquid egg white, 120 mL of water, 2 slices of toast, 30 g of jam or jelly, and no other ingredients. Nothing by mouth Protocol states that patient may not take anything by mouth for a minimum of 4 h. Meal ingestion time Protocol directs that the patient should eat the meal rapidly (in <10 min). Partial meal Protocol requires documentation of vomiting or of ingestion of only a portion of the meal. Radiopharmaceutical dose The prescribed radiopharmaceutical is 99mTc-SC, and the dose is 18.5–37 MBq (0.5–1.0 mCi), Acquisition Image projections Both anterior and posterior images are acquired. Image frequency Images are acquired immediately upon meal completion and hourly until 4 h. Processing Geometric mean Instructions are given to calculate the geometric mean using anterior and posterior projections (geometric mean = √ (anterior counts × posterior counts). Decay-corrected Protocol includes instructions for decay correction of counts in region of interest. Percentage retention Final measurements are reported as percentage of gastric retention at each time point. Meal type Ingredients Full consensus (using egg white) Egg white, white toast, jelly, and water Egg white partial Liquid egg white but only some of the other standard ingredients Egg white plus Liquid egg white meal plus addition of nonstandard ingredients such as butter or juice Whole egg meal Whole eggs substituted for egg whites, white toast, jelly, and water Whole eggs partial Whole eggs but only some of the other standard ingredients Whole eggs plus Whole egg meal plus addition of nonstandard ingredients such as butter or juice Oatmeal Oatmeal alone or combined with other ingredients Other Unusual meals such as a burrito or peanut butter sandwich Variable Category Data Laboratory type Hospital-based 80 (63.0%) Nonhospital 47 (37.0%) First time vs. reaccreditation application First time 5 (3.9%) Reaccredited 122 (96.1%) General nuclear medicine decision Delayed 76 (59.8%) Granted 51 (40.2%) Medical director ABNM-certified Yes 72 (56.7%) No 55 (43.3%) Any ABNM-certified staff Yes 85 (66.9%) No 42 (33.1%) Gastrointestinal study annual volume Mean ± SD 428.3 ± 460.3 Median 310 (range, 15–3,466) General nuclear medicine annual volume Mean ± SD 1,709.4 ± 1,805.2 Median 1,201 (range, 38–10,030) Number of medical staff (n = 880) Mean ± SD 9.6 ± 7.9 Median 7 (range, 1–38) Number of technical staff Mean ± SD 6.8 ± 6.0 Median 5 (range, 1–31) Number of γ-cameras Mean ± SD 4.0 ± 3.7 Median 3 (range, 1–22) Qualitative data are expressed as number and percentage; continuous data are expressed as mean ± SD, median, and range.
Group n Consensus meal (egg white, white toast, jelly, and water) Complete 39 (30.7%) Partial 3 (2.4%) Plus additional ingredients 3 (2.4%) Whole egg meal (whole eggs, white toast, jelly, and water) Complete 2 (1.6%) Partial 41 (32.3%) Plus additional ingredients 18 (14.2%) Oatmeal 15 (11.8%) Other meal types 6 (4.7%) Medication Generic name Brand name Manufacturer Prokinetic agents Metoclopramide Reglan Baxter Maxeran Sanofi Domperidone Motilium Janssen Erythromycin Opiates Codeine Fentanyl Duragesic Sandoz Hydrocodone Lortab Tris Pharma Lorcet Mikart Norco Actavis Vicodin Abbott Vicoprofen Halo Hydromorphone Dilaudid Purdue Pharma Meperidine Demerol Validus Methadone Dolophine West-Ward Methadose Mallinckrodt Morphine MS Contin Purdue Pharma Kadian Actavis Naloxone Narcan Adapt Pharma Oxycodone OxyContin Purdue Pharma Percocet Endo Percodan Endo Oxymorphone Opana Endo Anticholinergic or antispasmodic agents Atropine Belladonna tincture or leaf Belladonna alkaloids/phenobarbital Donnatal AvKARE Chloridiazepoxide/clidinium, chlordiazepoxide/methscopolamine, clidinium bromide Librax Valeant Dicyclomine Bentyl Aptalis Triactin Pharmed Hyoscyamine Levsin Alaven Hyoscyamine/phenyltoloxamine Digex Pronova Glycopyrrolate Robinul Shionogi Mepenzolate Cantil Sanofi Methscopolamine Pamine PharmaDerm Scopolamine Scopace Hope Other medications Benzodiazepine Ativan West-Ward Valium Roche Xanax Pfizer Nifedipine Adalat Bayer HealthCare Afeditab Alkermes Nifediac Teva Nifedical Teva Procardia Pfizer Octreotide SandoSTATIN Novartis Phentolamine OraVerse Septodont Regitine Novartis Progesterone Prometrium Catalent Theophylline Elixophyllin Nostrum Quibron Monarch Slo-Bid Aventis Slo-Phyllin Purdue Pharma Theoclear Central Pharm Theodur Schering-Plough Theolair 3M Uniphyl Purdue Pharma ↵* Unless determining a treatment response is the purpose of the GES study, medications that alter gastric emptying should be withheld for 48–72 h.
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