Gastroesophageal reflux scintigraphy with radioactive capsules--a new technique for detection and quantitation of reflux

Does the Capsule Method Increase the Accuracy of the Detection of Ger by Scintigraphy Technique?

Background

The scintigraphy technique is the most sensitive test for the detection of gastroesophageal reflux disease (GERD). Scintigraphy techniques employ two methods: the liquid method and the capsule method.

Aim

In this prospective study, we are trying to find out the efficiency of the capsule method for gastroesophageal reflux scintigraphy over the liquid method and to determine the ease of execution of the technique and the interpretation of the results.

Materials and Methods

A total of 65 symptomatic patients (age range: 7-71 years; mean age: 35.2 years) were included in the study. They were divided into two groups: group A, which included 18 patients who underwent the liquid method and Group B, which included 47 patients who underwent the capsule method. The average administered dose of 99mTc-labeled sulfur colloid was 11.1-18.5 MBq.

Results

The results showed that 45 (69.12%) of the 65 patients tested positive for GERD. Furthermore, 15 were positive in the liquid method and 30 in the capsule method. Grade III reflux was seen in 66.67% of patients, and 33.33% of patients with Grade II and I reflux were diagnosed using both methods.

Conclusion

Thus, in conclusion, we can say that both liquid and capsule methods are equally sensitive for the detection of low as well as high refluxate volumes.

A physiological manoeuvre to improve the positivity of the gastro-oesophageal reflux scintigraphic test

One of the best examinations used routinely to detect gastro-oesophageal reflux (GOR) is scintigraphy and attempts are continuously being made to improve the performance of the test. We have tested a new manoeuvre to improve the results. Three hundred and twenty eight patients (190 males and 138 females, aged 1 month to 84 years, average 4.47 years) were studied after a 12 h fast period with 100 MBq of 99Tcm-phytate, 50 ml volume, directly delivered into the stomach in a mixture of orange juice. All patients were strongly suspected of having GOR. Conventional acquisition was done for 20 min, at a rate of one frame every 20 s. In the middle of the examination, small children were put in the upright position and held there for a few seconds or released in a way that allowed movement; adults were asked to stand up and walk a few metres. The test was then continued for the remaining 10 min. The global index of positivity was 64.6% (76 positive cases in the first half of the examination and 134 positive cases only after the manoeuvre). The mean of GOR episodes observed in the positive cases without the manoeuvre was 0.5 per patient, significantly different from the mean of 1.59 noted after the manoeuvre (P<0.01). In 28 cases the manoeuvre increased either the intensity or the frequency of reflux previously detected without it. We believe that this manoeuvre should be performed in all scintigraphic tests aiming to detect GOR. In the present series, the manoeuvre increased the frequency of GOR episodes.