Perry Orthey1, Daohai Yu2, Mark L Van Natta3, Frederick V Ramsey2, Jesus R Diaz4, Paige A Bennett5, Andrei H Iagaru6, Roberto Salas Fragomeni7, Richard W McCallum8, Irene Sarosiek8, William L Hasler9, Gianrico Farrugia10, Madhusudan Grover10, Kenneth L Koch11, Linda Nguyen12, William J Snape13, Thomas L Abell14, Pankaj J Pasricha15, James Tonascia3, Frank Hamilton16, Henry P Parkman17, Alan H Maurer. 1. Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania. 2. Department of Clinical Sciences, Temple Clinical Research Institute, Temple University School of Medicine, Philadelphia, Pennsylvania. 3. Data Coordinating Center, Johns Hopkins University, Baltimore, Maryland. 4. Nuclear Medicine Section, Texas Tech University, El Paso, Texas. 5. Nuclear Medicine Section, Wake Forest University, Winston Salem, North Carolina. 6. Nuclear Medicine Section, Stanford University, Palo Alto, California. 7. Nuclear Medicine Section, Johns Hopkins University, Baltimore, Maryland. 8. Section of Gastroenterology, Texas Tech University, El Paso, Texas. 9. Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan. 10. Section of Gastroenterology, Mayo Clinic, Rochester, Minnesota. 11. Section of Gastroenterology, Wake Forest University, Winston Salem, North Carolina. 12. Division of Gastroenterology, Stanford University, Palo Alto, California. 13. Division of Gastroenterology, California Pacific Medical Center, San Francisco, California. 14. Division of Gastroenterology, University of Louisville, Louisville, Kentucky. 15. Section of Gastroenterology, Johns Hopkins University, Baltimore, Maryland. 16. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; and. 17. Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania henry.parkman@temple.edu.
Abstract
Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers' (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0 Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients' symptoms.
Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers' (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0 Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients' symptoms.
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