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Gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG): detection by a simple
K K Balan1, S Vinjamuri, P Maltby
1Department of Nuclear Medicine, Royal Liverpool University Hospital, United Kingdom.
Objectives:
Gastroesophageal scintigraphy has been described as a sensitive and accurate way to detect and quantitate gastroesophageal reflux (GER). Our objectives here were to evaluate the usefulness of a modified scintigraphic technique in the detection of GER and lung aspiration in patients fed by percutaneous endoscopic gastrostomy (PEG), and to assess the incidence of GER after insertion of PEG. Further, we sought to examine whether or not the underlying cause of dysphagia plays any significant part in the causation of GER.
Methods:
Twenty-two patients, 13 with neurological dysphagia and nine with mechanical dysphagia, were studied. Each patient received 25 MBq of Tc-99m-tin colloid in orange juice followed by 300 ml of normal saline through the PEG tube. Dynamic and static images were taken immediately and at 4 h over esophagus, stomach, and lungs.
Results:
Twelve patients (10 with neurological dysphagia) had GER and one had aspiration into the lungs. In all but one patient GER occurred in the immediate postprandial period.
Conclusions:
Scintigraphy is useful in assessing GER in PEG-fed patients. We also note that GER is a major problem in patients with PEG, especially in those with neurological dysphagia.