Nuclear Gastric Emptying Studies: All That Glitters Is Not the Gold Standard
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EDITORIAL
Nuclear Gastric Emptying Studies: All That Glitters Is Not the Gold Standard Lucinda A. Harris1 Accepted: 2 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
The radionuclide gastric emptying test (GET) is the gold standard for diagnosing gastroparesis. Although commonly performed by most nuclear medicine departments, there are many subtleties and nuances that improve its performance characteristics. As an example, the preparation is not just “nothing to eat after midnight,” since there are key measures that should be followed in order to obtain the most accurate results. The existing guidelines were endorsed by the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine in 2008 [1]. Recommendations state that patients should be instructed to stop medications that might accelerate gastric emptying such as metoclopramide or that slow emptying such as opiates or anticholinergics for 48 h before the test. There is a validated meal of 4 oz. of liquid egg whites labeled prior to cooking with 0.5–1.0 mCi 99mTc sulfur colloid, 2 slices of white bread, 30 gm of strawberry jam, and a glass of water, all of which should be consumed in 10 min or less [2]. Another important requirement is that the blood sugar should be ≤ 275 prior to the test in order to improve test reliability. Cigarette smoking (not just marijuana) is not allowed the morning of or throughout the test. Moreover, many radiology departments report gastric emptying in terms of a 90-min half-life. Unfortunately, although this saves time, to the disciples of motility and the original creators of the GET, this is unacceptable, since the test was developed and validated based on observations that tested the effects of meal size, fat content, consistency, and liquid volume, and also studied methods of tracer incorporation while defining the area of interest and timing of image acquisition [3]. For instance, standardization of fat content is extremely important as it can slow gastric emptying and a liquid meal alone has been noted to be too rapid [1, 4]. Acquisition of images in the standing position was also adopted because acquiring images in the prone position * Lucinda A. Harris [email protected] 1
Mayo Clinic, Phoenix, USA
has been found to slow gastric emptying [3]. According to the results of considerable experimentation, the ideal test reports the percent retention at 1, 2, and 4 h with a positive test demonstrating > 10% retention at 4 h. A 1 h image is considered essential to capture those individuals with rapid gastric emptying [5]. As part of the study, there should be a statement recorded regarding whether patients consumed the whole meal, or if they vomited any of the meal, and medications that were consumed within 24 h of having the test done. There are also additional features regarding image acquisition and interpretation by radiologists [2]. In this issue of Digestive Diseases and Sciences, Wise et al. from the Mayo Clinic Jacksonville sent an IRB approved quest
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