Enhanced Gastric Emptying Scintigraphy to Assess Fundic Accommodation Using Intragastric Meal Distribution and Antral Contractility

Gastric emptying scintigraphy (GES) as now commonly performed measures only total gastric emptying. Intragastric meal distribution (IMD) immediately after meal ingestion (t = 0 min) (IMD0) can assess fundic accommodation, and dynamic antral contraction scintigraphy (DACS) can assess antral motility. Our goals were to incorporate IMD and DACS into GES, compare IMD0 using gastric division into anatomic proximal and distal halves versus more physiologic separation of the antrum from the proximal stomach using DACS, and establish reference values. Methods: Healthy subjects (n = 20) underwent GES using a solid-liquid meal. DACS (1 frame/3 s) was performed for 20 min after each static imaging time. IMD0 was measured using both semiautomated software to divide the gastric long axis into anatomic halves and Fourier analysis to identify antral pixels with phasic contractions. Results: Using halving of the stomach, IMD0 averaged 0.75 +/- 0.15 (SD). Using phasic contractions to define the antrum, mean IMD0 was 0.85 +/- 0.14 (P = 0.004). Sustained antral contractions started at a mean of 11.24 +/- 12.98 min after meal ingestion and originated in the gastric midbody with a starting location at 40.5% +/- 10.8% from the distal to the proximal stomach along its long axis. Antral frequency and ejection fraction peaked 30 min after meal ingestion at 3.30 +/- 0.71 contractions per minute and an ejection fraction of 30.3% +/- 13.69%, when mean antral filling peaked at 36.7% +/- 14%. Maximum antral contraction speed was 3.54 +/- 0.90 mm/s at 60 min after meal ingestion. Gastric retention was 39.8% +/- 12.8% at 2 h and 5.8% +/- 6.0% at 4 h. Conclusion: Addition of DACS to GES permits physiologic characterization of both fundic accommodation and antral contractility to supplement routine GES.