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Assessing the Clinical Value of 2-h Versus 4-h Gastric Emptying Scintigraphy in Pediatrics: A Systematic Review and
Ryan Shargo1, Michael Luongo1, Rahul Mhaskar1,2
1University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
Insights
The 4-hour gastric emptying scintigraphy (GES) scan is more effective for diagnosing gastroparesis in children than the 2-hour scan. The longer study duration identified 10% more cases, improving diagnostic yield for pediatric gastroparesis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Medical Diagnostics
Background:
- Gastric emptying scintigraphy (GES) is the gold standard for diagnosing gastroparesis.
- Adult guidelines recommend a 4-hour GES, but pediatric guidelines are lacking.
- Shorter 2-hour scans are often used in children to reduce radiation and save time.
Purpose of the Study:
- To compare the diagnostic accuracy of 2-hour versus 4-hour GES in pediatric gastroparesis.
- To evaluate the differences in gastroparesis diagnosis between 2-hour and 4-hour GES.
- To determine the added diagnostic value of extending GES from 2 to 4 hours in children.
Main Methods:
- Systematic review and meta-analysis of pediatric GES studies.
- Searched four databases for studies reporting both 2-hour and 4-hour GES results.
- Analyzed the proportion of patients diagnosed with gastroparesis at each time point and changes in transit status.
Main Results:
- Six studies involving 344 records were included in the meta-analysis.
- The 4-hour GES identified an additional 10% of pediatric patients with gastroparesis.
- Significant heterogeneity was observed (I² = 91.8%), likely due to protocol and sample variations.
Conclusions:
- The 4-hour GES demonstrates a higher diagnostic yield for pediatric gastroparesis compared to the 2-hour scan.
- Despite study heterogeneity, the extended duration provides a more comprehensive assessment.
- Further prospective research is needed to precisely quantify the benefit of 4-hour GES in children.
Introduction:
The gold-standard diagnostic test for gastroparesis is gastric emptying scintigraphy (GES). Although a 4-h GES is recommended in adult guidelines, no similar guidelines exist in the pediatric population, with many hospitals utilizing a 2-h scan to reduce radiation exposure and save time.
Methods:
We performed a systematic review and meta-analysis to evaluate differences in the diagnosis of gastroparesis during 2-h versus 4-h GES. Four databases were systematically searched for articles reporting results of GES at both the 2- and 4-h time points in a pediatric population. Outcomes included the proportion of patients with gastroparesis at 2- and 4-h and the number of patients with differing transit status (normal or abnormal) from 2- to 4-h. Meta-analyses were conducted utilizing a random effects model. Heterogeneity among studies was assessed utilizing the I2 statistic.
Key Results:
A total of 344 records were identified, of which 9 articles met inclusion criteria. Of these, six articles were included in the meta-analysis. The pooled proportion of patients with alterations in gastric transit between 2 and 4 h was 0.2 (95% CI: 0.11 to 0.30). Overall, the extended 4-h scan captured an additional 10% of patients with gastroparesis. There was significant heterogeneity among the studies (I2 = 91.8%, p < 0.001), likely due to differences in GES protocol and patient samples.
Conclusions And Inferences:
The 4-h GES offers a higher diagnostic yield in pediatric patients compared to a 2-h study, despite heterogeneity in existing research. Further prospective studies are necessary to further quantify this advantage.
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