Considerations and Indications for Gastric Emptying Scintigraphy in Lung Transplant Patients

Gastroparesis is a complication following lung transplantation. This study aimed to assess the prevalence of gastroparesis in patients with lung transplants undergoing solid phase gastric emptying scintigraphy (GES). Specifically, we investigated which type of lung transplant is more susceptible to gastroparesis and whether timing of GES post-transplantation impacts diagnosis of severe gastroparesis.

This retrospective analysis included lung-transplant recipients between January 2008 and February 2024, who underwent GES. Patients received a standardized egg sandwich labeled with 500 uCi Technetium-99m sulfur colloid. GES results were compared to normal values for percentages retained at 2- and 4-hours post-meal.

Among 485 lung-transplant recipients, 111 (50% male; mean age 63 years) underwent posttransplant GES. Gastroparesis was diagnosed in 23% of lung transplant recipients during the study period. Of those who underwent GES, 67% exhibited delayed gastric emptying, with 38 patients (34%) demonstrating severe retention (>30% at 4 hours). Delayed gastric emptying rates were highest in bilateral lung transplant recipients (73%), followed by left (66%) and right (56%) lung transplant recipients. Timing of GES beyond 6 months or one-year post-transplant did not significantly increase the incidence of delayed gastric emptying (p>0.05). There was no significant difference in proportion of patients with delayed gastric emptying when patients were stratified by gender and age.

Our findings suggest that laterality of lung transplant does not influence risk of delayed gastric emptying. Moreover, early evaluation of gastrointestinal symptoms with GES did not impact the severity or rate of gastroparesis. We recommend routine screening with GES for symptomatic lung transplant recipients, irrespective of transplant timing, to facilitate timely management and reduce post-operative complications associated with gastroparesis.