Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis

Gastric emptying scintigraphy (GES) is usually performed for up to 2 hr to measure the gastric emptying (GE) of solids. Symptomatic patients, however, may have borderline results at 2 hr, making it difficult to determine whet her a gastric motor disorder is present. The aim of this study was to asses s whether extending GES to 4 hr is useful in evaluating patients for gastro paresis and to correlate the results of GES with patient symptoms. We studi ed 129 patients undergoing GES at Temple University Hospital between July 1 998 and March 1999. Solid-phase GE was measured at 0, 0.5, 1, 2, 3, and 4 h r after ingestion of a Tc-99m sulfur colloid-labeled egg meal. Dyspeptic sy mptoms of upper abdominal discomfort, early satiety, postprandial abdominal bloating, nausea, vomiting, and anorexia were graded as none, mild, modera te and severe (0, 1, 2 and 3, respectively) with the sum representing a tot al symptom score. Of 129 patients, 86 had normal GE at 2 hr; 26 of the 86 n ormal scans at 2 hr were delayed at 3 hr. Six of the 60 scans normal at 2 a nd 3 hr were delayed at 4 hr. Of 43 patients with delayed GE at 2 hr, 39 we re delayed at 3 hr and 35 were delayed at 4 hr. Overall, the percentage of patients with delayed GE increased from 33% at 2 hr only to 58% using the r esults of the 2-, 3-, and 4-hr scans (P < 0.05). There was a significantly greater symptom score in patients with delayed GE compared to patients with normal GE (8.4 <plus/minus> 0.5 vs 7.1 +/- 0.5; P < 0.05). Conclusion, pro longing GES after ingestion of a Tc-99m-labeled egg meal from 2 to 3 hr inc reased the number of symptomatic patients found to have delayed GE. These r esults suggest that GES should be performed for up to 4 hrs when the 2-hr r esult is normal.