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Pediatric gastric emptying: value of right lateral and upright positioning
J Villanueva-Meyer1, L E Swischuk, F Cesani
1Department of Radiology, University of Texas Medical Branch, Galveston 77555-0793, USA.
Insights
Changing infant position significantly improves gastric emptying assessment. Studies show that adding right lateral and upright views after initial supine imaging enhances detection of normal gastric emptying in infants.
Area of Science:
- Pediatric Gastroenterology
- Nuclear Medicine Imaging
Background:
- Gastroesophageal reflux and gastric emptying studies in infants are often performed simultaneously.
- The standard 1-hour supine imaging protocol may delay gastric emptying assessment.
Purpose of the Study:
- To evaluate the impact of positional changes on gastric emptying measurements in infants.
- To determine if modified imaging protocols improve the detection of normal gastric emptying.
Main Methods:
- 48 infants (1 week to 2 years) with vomiting or failure to thrive underwent gastric emptying studies.
- A radiolabeled formula (99mTc-sulphur colloid) was administered, followed by 1-hour supine imaging.
- Additional imaging included 30 minutes in the right lateral decubitus position and 30 minutes upright.
Main Results:
- Supine imaging at 60 minutes showed 35% +/- 19% gastric emptying.
- In the right lateral position at 90 minutes, emptying increased to 60% +/- 25%.
- Upright imaging at 120 minutes showed 73% +/- 20% emptying. The number of studies showing significant emptying (>40%) increased from 19 to 41 (right lateral) and 45 (upright).
Conclusions:
- Many infants with delayed gastric emptying demonstrate significant emptying upon positional changes.
- Routine addition of right lateral and upright views enhances the diagnostic yield of infant gastric emptying studies.
Unlabelled:
Gastroesophageal reflux and gastric emptying are usually assessed simultaneously with a 1-hr procedure. After ingestion of radiolabeled formula sequential images are gathered when the infant is in the supine position. This position is adequate for gastroesophageal reflux assessment, but delays gastric emptying.
Methods:
We studied 48 children, 1 wk to 2 yr of age, who presented with vomiting or failure to thrive. They received 99mTc-sulphur colloid in formula. After completing 1 hr supine imaging we obtained additional abdominal views after changing the position of the infant to right lateral for 30 min, and upright for another 30 min.
Results:
The percent of gastric emptying at 60 min in the supine position was 35% +/- 19%. After 90 min, in the right lateral decubitus, the percent gastric emptying was 60% +/- 25%. At 120 min, after an upright period, the gastric emptying was 73% +/- 20%. In the supine position 19 of 48 patients showed significant emptying (defined as > 40% emptying). This increased to 41 of 48 normal studies considering the right lateral position and to 45 of 48 normal studies considering the infant upright position.
Conclusion:
Many patients with delayed gastric emptying show significant emptying just by changing position. We routinely complement gastric emptying studies with delayed views in the right lateral and upright position.