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Small Bowel Transit Scintigraphy in Children With Pediatric Intestinal Pseudo-Obstruction
Atchariya Chanpong1,2,3,4, Elizabeth Morris5,6, Lorenzo Biassoni5
1Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom.
Insights
Small bowel scintigraphy (SBS) effectively assesses pediatric intestinal pseudo-obstruction (PIPO) by measuring small bowel transit (SBT). This method is particularly useful for differentiating myopathic from neuropathic PIPO, aiding diagnosis in children with gastrointestinal dysmotility.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Gastrointestinal Motility Disorders
Background:
- Pediatric Intestinal Pseudo-obstruction (PIPO) diagnosis relies on objective evidence of small intestinal dysmotility.
- Small Bowel Scintigraphy (SBS) measures small bowel transit (SBT) but has limited pediatric data.
- Evaluating SBS utility in children with suspected gastrointestinal dysmotility is crucial.
Purpose of the Study:
- To assess the diagnostic utility of Small Bowel Scintigraphy (SBS) in children suspected of gastrointestinal dysmotility.
- To evaluate SBS for diagnosing and characterizing Pediatric Intestinal Pseudo-obstruction (PIPO).
- To compare SBT in PIPO patients versus non-PIPO patients and correlate with antroduodenal manometry (ADM).
Main Methods:
- Retrospective analysis of 59 pediatric patients (2016-2022) undergoing extended gastric emptying studies for SBT assessment.
- PIPO classification based on antroduodenal manometry (ADM) findings.
- Comparison of SBS parameters, including colonic filling at 6 hours, between PIPO and non-PIPO groups.
Main Results:
- PIPO patients showed significantly lower colonic filling at 6 hours compared to non-PIPO patients (liquid: 48% vs 83%; solid: 5% vs 65%).
- Small bowel transit (SBT) was significantly slower in myopathic PIPO compared to neuropathic PIPO for both liquid and solid meals.
- A significant negative correlation was observed between solid SBT and ADM scores (r = -0.638, P = 0.036).
Conclusions:
- Small Bowel Scintigraphy (SBS) is a feasible method for assessing pediatric small intestinal motility.
- SBS demonstrates potential utility in diagnosing and characterizing Pediatric Intestinal Pseudo-obstruction (PIPO).
- SBS appears most effective in differentiating myopathic PIPO; further studies in larger pediatric cohorts are warranted.
Introduction:
Objective evidence of small intestinal dysmotility is a key criterion for the diagnosis of pediatric intestinal pseudo-obstruction (PIPO). Small bowel scintigraphy (SBS) allows for objective measurement of small bowel transit (SBT), but limited data are available in children. We aimed to evaluate the utility of SBS in children suspected of gastrointestinal dysmotility.
Methods:
Patients undergoing gastric emptying studies for suspected foregut dysmotility, including PIPO, from 2016 to 2022 at 2 tertiary children's hospitals were recruited to an extended protocol of gastric emptying studies to allow for assessment of SBT. PIPO was classified based on antroduodenal manometry (ADM). SBT was compared between PIPO and non-PIPO patients. Scintigraphic parameters were assessed and correlated against ADM scores.
Results:
Fifty-nine patients (16 PIPO and 43 non-PIPO diagnoses) were included. SBS was performed with liquid and solid meals in 40 and 26 patients, respectively. As compared to the non-PIPO group, PIPO patients had a significantly lower median percentage of colonic filling at 6 hours, with both liquid (48% vs 83%) and solid tests (5% vs 65%). SBT in PIPO patients with myopathic involvement was significantly slower than in patients with neuropathic PIPO, both for liquid and solid meal. A significant correlation was found between solid SBT and ADM scores (r = -0.638, P = 0.036).
Discussion:
SBS provides a practically feasible assessment of small intestinal motility. It shows a potential utility to help diagnose and characterize PIPO. SBS seems most discriminative in PIPO patients with myopathic involvement. Studies in a larger pediatric population and across different ages are required.
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