Gastric emptying scintigraphy

What is gastric emptying scintigraphy?

Gastric emptying scintigraphy is a nuclear medical examination that can be used to assess the speed of gastric emptying. This involves eating a test meal containing a small amount of radioactive particles. Images of the stomach are then taken over a period of several hours using a gamma camera, which can make the radiation visible, to assess the rate of gastric emptying.

The advantages of this diagnostic method include that it is easy to carry out, that it is non-invasive and that patients are exposed to less radiation in comparison to other radiological examinations such as a computer tomography. Nevertheless, the lack of standardization is an issue, as different test meals, body positions and other factors have an influence on the speed of gastric emptying.

Why is a gastric emptying scintigraphy performed?

A gastric emptying scintigraphy is typically performed when there is suspicion of gastroparesis (literally translated as stomach paralysis) or another condition that leads to delayed gastric emptying. Symptoms that may indicate this condition if they appear after eating are, for example:

• Nausea and vomiting
• Upper abdominal pain
• Feeling full quickly

In most cases where gastroparesis is diagnosed, no specific cause can be identified. The most common identifiable cause is diabetes mellitus, with obesity and poorly controlled blood sugar levels increasing the risk of diabetic gastroparesis. Other possible triggers for gastroparesis include:

• Medications, such as opioids
• Neurological disorders, such as Parkinson's disease
• Bariatric surgeries (surgeries aimed at weight loss in cases of severe obesity)
• Other rare diseases, such as amyloidosis

Gastric emptying disorders can also occur in cases of reflux disease or a peptic ulcer.

Additionally, gastric emptying can be slowed by a stenosis (narrowing) at the gastric outlet or in the small intestine. This can be congenital or caused by a tumor growing into the intestinal lumen. Such a mechanical obstruction should be ruled out by an endoscopy or X-ray before performing a gastric emptying scintigraphy.

The dumping syndrome, a condition of too rapid gastric emptying, is rarer and can occur after stomach surgeries. If suspected, a gastric emptying scintigraphy can be performed to confirm the diagnosis.

What preparations are needed for a gastric emptying scintigraphy?

To prepare for the scan, patients should have fasted (no food or liquids) for at least six hours. The bladder and bowel should be emptied shortly beforehand. Smoking should also be avoided on the day of the examination until after the images have been taken.

Some specific medications, like tricyclic antidepressants and metoclopramide, should be stopped where possible. This will be discussed during the information session that takes place before the procedure.

Failure to comply with these measures can falsify the test results.

In addition, it should be noted that because of the radiation exposure, a gastric emptying scintigraphy should not be done if one has already been carried out in the last three months. This examination must not be carried out on pregnant women. Should it be urgently necessary for breastfeeding women, breastfeeding must be discontinued for 48 hours afterwards so as not to endanger the child.

How is a gastric emptying scintigraphy performed?

The examination is typically conducted with the upper body elevated. The patient quickly consumes a test meal that is radioactively labeled, usually with technetium. These radioactive particles are not noticeable while eating. For patients with swallowing difficulties, the scintigraphy can be performed with test meals of varying consistency, such as porridge or thickened liquids. However, solid foods provide the most meaningful results.

After eating, a series of images of the stomach are taken over a period of two hours using a gamma camera. This special camera can make radioactive radiation visible, thereby allowing the movement of the meal through the body to be seen completely non-invasively. The images from the gamma camera are then analyzed using computer software, which can represent the gastric emptying process as a curve.

If there is a suspicion of reflux disease, additional images of the esophagus may be taken at a later time.

Gastric emptying scintigraphy is completely painless for the patient.

Are there any risks or possible side effects of a gastric emptying scintigraphy?

The radiation exposure to which patients are exposed during a gastric emptying scintigraphy is relatively low, at around 1mSv. This is approximately half of the average annual natural radiation exposure in Germany and about one fifth of the effective radiation dose during a CT scan of the chest.

Nevertheless, even a low radiation exposure leads to an increased risk of cancer in the statistics.

In cases of impaired bladder emptying, radiation exposure may be increased, as the radioactive particles are excreted more slowly and therefore remain in the body for a longer period. Any known issues should be discussed with the doctor beforehand and, if necessary, quantified.

Which doctors & clinics specialize in gastric emptying scintigraphy?

Doctors from various specialties can make the decision to perform a gastric emptying scintigraphy based on a suspected diagnosis, which the test is intended to confirm or rule out. Disorders of gastric emptying can be relevant in fields such as general medicine, internal medicine, visceral surgery, neurology, pain medicine, and palliative care.

The planning, execution, and evaluation of the examination are the responsibility of nuclear medicine, and can be performed by either the nuclear medicine departments of a hospital or nuclear medicine practices.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of gastric emptying scintigraphy. They are looking forward to and are ready to address your questions and treatment requests.