ASSESSMENT OF SUCRALFATE COATING BY SEQUENTIAL SCINTIGRAPHIC IMAGING IN RADIATION-INDUCED ESOPHAGEAL LESIONS

The value of mucosal protection with sucralfate in cases of gastric ul ceration is well documented. Although sucralfate is advocated as treat ment of esophageal lesions, we found it to be of limited value in the management of radiation-induced esophagitis; in a pilot study of 10 ca ses, minor relief of symptoms, with analgetics still required, was not ed in 4 patients, and no improvement was seen at endoscopy after 6 wee ks of treatment in any patient. To see if this might be the result of inadequate mucosal coating, we administered sucralfate labeled with te chnetium 99m to 26 patients with endoscopically proven esophagitis sec ondary to irradiation for esophageal carcinoma. The degree of coating was evaluated according to persistence of the radionuclide in the affe cted esophageal segment. Scans were performed at regular intervals for 120 minutes after administration of 150 MBq Tc-99m-sucralfate. Althou gh scans were positive for radioactivity in 24 of 26 (99%) patients, o nly 8 (31%) of these represented selective binding of sucralfate to ti ssue. In the other 16 cases, scans were positive for sucralfate and al bumin, indicating nonspecific retention most likely caused by concomit ant esophageal stenosis. Residual radioactivity was observed for 30 mi nutes or more in 11 (42%) patients, but scans were positive for radioa ctivity after 1 to 2 hours in only 4 (15%). The duration and intensity of tracer accumulation were similar in both acute lesions and chronic radiation damage. These findings suggest that the inability of sucral fate to alleviate irradiation-induced odynophagia may be related to in sufficient duration of adherence of this compound to damaged esophagea l mucosa.