Update on Gastrointestinal Scintigraphy

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Nuclear medicine offers a variety of studies for evaluating motility throughout the gastrointestinal tract. Gastric emptying remains the “gold standard” for studying gastric motor function, but its application in most centers remains limited to measuring only total gastric emptying in spite of data that show assessment of both fundal and antal function is of clinical value for evaluating patients with dyspepsia. Similarly, newer methods to study small bowel and colon transit have not gained widespread use. This review summarizes the state-of-the-art of prior established and newer scintigraphic studies with an emphasis on their clinical applications.

Section snippets

Esophageal Transit

Which diagnostic study is used to evaluate a patient for esophageal dysmotility depends on the patient’s symptoms. If dysphagia is present, a barium swallow, computed tomography (CT), or endoscopy usually is performed first to exclude an anatomic lesion. If anatomic studies are not diagnostic, manometry is then usually performed. In our experience, use of esophageal transit scintigraphy (ETS) is limited to when these other studies are nondiagnostic or when there is a need to quantitiate

Adult Studies

GER scintigraphy was developed in adults to both detect and quantitate reflux. There have been no significant recent developments in the method to perform GER scintigraphy. Adults typically drink 300 μCi of 99mTc-SC suspended in 150 mL of orange juice mixed with 0.1 N of HCl. The patient is imaged supine under a gamma camera, and an abdominal binder is used to increase abdominal pressures in 20-mm increments up to 100 mm Hg. Computer images are recorded for 30 seconds at each level of binder

Gastric Emptying

Patients referred for GE studies often do not have well-defined GI symptoms and present with complaints of dyspepsia (GI symptoms thought to originate in the upper GI tract). Gastroparesis is usually associated with upper-GI symptoms, including nausea (92%), vomiting (84%), distention (75%), or early satiety (60%).26 In 50% of patients, no cause is found, and the dyspepsia is classified as idiopathic, essential, functional, or nonulcer dyspepsia.27 An excellent review of the gastrointestinal

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