Gastric Emptying Studies in Pediatrics: A Cincinnati Children’s Hospital Experience

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FIGURE 1.
Epic schedule template for gastric emptying studies. Central scheduling can schedule 3 gastric emptying studies in 1 d. Scheduling template is blocked as “permission” in afternoon to allow for gastric emptying studies to be performed over 4 h.
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FIGURE 2.
Flow diagram of gastric emptying studies starting with dual-phase gastric emptying. Changes based on what patient can be fed are permitted.

TABLE 1.

Gastric Emptying Dose Chart

Examination	Radiopharmaceutical	Target dose	Other
Dual-phase gastric emptying	Solid (^99mTc-sulfur colloid)	7.4 MBq (0.200 mCi)	Liquid eggs
	Liquid (⁶⁷Ga-citrate)	3.0 MBq (0.080 mCi)	Water or apple juice
Solid gastric emptying	^99mTc-sulfur colloid	7.4 MBq (0.200 mCi)	Liquid eggs or Ensure Plus
Liquid gastric emptying	^99mTc-sulfur colloid	7.4 MBq (0.200 mCi)	Patient formula or water
Liquid gastric emptying gastroesophageal reflux	^99mTc-sulfur colloid	9.3 MBq (0.250 mCi)	<2 y
		11.1 MBq (0.300 mCi)	2–4 y
		14.8 MBq (0.400 mCi)	≥5 y

Radiopharmaceutical dose chart taken from Cincinnati Children’s Hospital Medical Center’s Department of Nuclear Medicine radiopharmaceutical target dose schedule. ^99mTc-macroaggregated albumin can be substituted for ^99mTc-sulfur colloid if ^99mTc-sulfur colloid is not available. ^99mTc-DTPA can be used for clear-liquid gastric emptying studies using water.

TABLE 2.

Reference Values for Various Types of Gastric Emptying Studies

Study type	Reference value
Dual phase with egg (4-h study) (delayed solid emptying at 2 or 4 h is considered abnormal; delayed clear emptying at 1 or 2 h is considered abnormal)	Liquid: >40% at 1 h; >78% at 2 h
	Solid: >10% but <70% at 1 h; >40% at 2 h; >90% at 4 h
Solid-only with egg (4-h study) (delayed solid emptying at 2 or 4 h is considered abnormal)	>10% but <70% at 1 h; >40% at 2 h; >90% at 4 h
Solid-only with Ensure Plus (4-h study)	>10% but <70% at 1 h; >40% at 2 h; >90% at 4 h
Solid-only with oatmeal (1-h study)	>50% at 1 h
Liquid-only with formula or milk (2-h study)	>51% at 2 h
Clear liquid–only with water (30-min study)	Half-time < 25 min