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Gastroparesis in Children: The Benefit of Conducting 4-hour Scintigraphic Gastric-Emptying Studies

Chogle, Ashish; Saps, Miguel

Journal of Pediatric Gastroenterology & Nutrition: April 2013 - Volume 56 - Issue 4 - p 439–442
doi: 10.1097/MPG.0b013e31827a789c
Original Articles: Gastroenterology

Background and Aim: Scintigraphic gastric emptying study (GES) is the criterion standard for diagnosis of gastroparesis. Adult studies demonstrated that extending GES to 4 hours increases its ability to diagnose delayed gastric emptying. Most pediatric centers assess GES up to 2 hours postmeal. The aim of the present study was to assess the effect of extending GES from 2 to 4 hours in evaluation of children with suspected gastroparesis.

Methods: We conducted a chart review of all children who had a 4-hour GES with standard radiolabeled solid meal in 2009–2010. Results of GES at 1, 2, and 4 hours were compared. Patients were diagnosed as having gastroparesis using adult criteria: if gastric retention of meal was >90%, 60%, and 10% at 1, 2 and 4 hours, respectively. A telephone survey assessed GES time at top 20 pediatric gastroenterology centers in the United States. Cost of evaluation of patients diagnosed as having gastroparesis was estimated. Full-time equivalents of nuclear medicine technicians and number of nuclear medicine studies done at Ann & Robert H. Lurie Children's Hospital of Chicago from 2007 to 2010 were examined.

Results: A total of 71 patients (32 boys, average age 10.8 years) were studied. Sixty-two percent (n = 44) children had abnormal GES; 23% (8/35) of them who had normal values at 2 hours had abnormal GES at 4 hours (P < 0.0001). Twenty-eight percent of patients had delayed GES at 1 hour: all persisted to have abnormal GES at 2 and 4 hours. Cost of evaluation of a child for gastroparesis was $9014. Only 5 of the top 20 pediatric gastroenterology centers in the United States conducted 4-hour GES. Transitioning from 2 hours to 4 hours only required scheduling adjustments and did not result in limitation in the number of scheduled patients.

Conclusions: Extending GES to 4 hours results in a considerable increase in diagnosis of gastroparesis.

Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.

Address correspondence and reprint requests to Dr Ashish Chogle, MD, MPH, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL 60611-2605 (e-mail: achogle@luriechildrens.org).

Received 23 January, 2012

Accepted 22 October, 2012

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN