technetium-tc-99m-lidofenin and Bile-Reflux

Various problems are encountered in measuring gastric emptying, especially relating counts to the volume of meal remaining in the stomach. We have developed a method which has been validated against aspiration of the stomach. In gastric ulcer patients, however, the stomach is large and overlaps the bowel. Results of gastric emptying studies in patients who have had surgery for peptic ulceration show that impaired gastric emptying is related to the extent of vagotomy and pyloric surgery. We have examined the pattern of biliary excretion of iminodiacetic acid derivatives and related enterogastric reflux to the amount of bile in the stomach as determined by aspiration. However the reproducibility is only 75% probably due to day to day variation in its occurrence. The incidence of reflux in control subjects and in those with peptic ulcer is discussed, as is its relationship to the extent of vagotomy and the length of Roux-en-Y loops. Finally the diagnosis of biliary atresia using a similar radiopharmaceutical is described. It has been suggested that a high liver to heart ratio excludes the diagnosis of atresia, but we have failed to confirm this finding.

Topics: Bile Reflux; Biliary Atresia; Child; Digestive System; Digestive System Physiological Phenomena; Gastric Emptying; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Duodenogastric Reflux; Gastric Emptying; Gastritis; Humans; Imino Acids; Organometallic Compounds; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Gastritis; Gastrointestinal Motility; Humans; Imino Acids; Postgastrectomy Syndromes; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Bile Reflux; Diagnosis, Differential; Esophagus; Female; Gastrectomy; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Topics: Bile Ducts; Bile Reflux; Common Bile Duct; Duodenogastric Reflux; Duodenum; Evaluation Studies as Topic; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Situs Inversus; Stomach; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to reconstitute the alimentary tract. The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear Stapler 3-4 centimeters from the biliary anastomosis. In this way, by employing the same loop without mesenteric interruption, two functional excluded loops will be obtained. The rationale of the suggested model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a stagnant cul-de-sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of leakage, a pure biliary and/or pancreatic fistula as far as is possible. 99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction, showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any alkaline enterogastric reflux.

Topics: Anastomosis, Roux-en-Y; Bile Reflux; Biliary Tract; Humans; Imino Acids; Intestines; Jejunum; Methods; Organotechnetium Compounds; Pancreaticoduodenectomy; Radionuclide Imaging; Reoperation; Stomach; Technetium Tc 99m Lidofenin

The aim of this study was to develop a new computerized gammagraphic method to evaluate gastrooesophageal (GER), bileo-oesophageal (BER) and bileogastric reflux (BGR) simultaneously with gastric and gallbladder emptying: a long duration (60 min) and a dual energy detection (113Inm-sulphur colloid and 99Tcm-HIDA) test of the different refluxes during slow gastric emptying of an enteric feeding liquid meal. Forty patients with oesophagitis and 18 normal volunteers were evaluated. Good reproducibility of all the quantified parameters was found with r Spearman between 0.75 (P < 0.05) and 1.0 (P < 0.001). Patients with oesophagitis have a tendency for slower gastric emptying patterns (gastric emptying T1/2, GT1/2 P < 0.05). The calculated specificity for gallbladder emptying parameters was 77.8% for the gallbladder T1/2 BT1/2) and 94.4% for gallbladder residue at 60 min (BR60). The calculated accuracy for the GER index was 90%. The predictability for positive values was 95%, owing to a 90% sensitivity and 89% specificity. The predictability for negative values was 80%. The mean GER index in oesophagitis was greater than in controls (P < 0.001). The calculated specificity for BGR was 94.4% and reflux was detected in 12 out of 40 patients. The calculated specificity for BER was 83.3% for a '+' index and 94.4% for a '++' BER index. In 14 patients a positive BER index has been determined ('+' in three and '++' in 11 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bile Reflux; Female; Gallbladder Emptying; Gastric Emptying; Gastroesophageal Reflux; Humans; Imino Acids; Indium; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium Tc 99m Lidofenin

The purpose of this study was to validate a new technique for measuring duodenogastric bile reflux in the human subject. A custom built cadmium telluride gamma detector (Radiation Monitoring Devices, Mass), small enough to be passed into the oesophagus and stomach, was developed and tested for sensitivity to 99Tcm and 75Se radioisotopes. When immersed in radiolabelled water, the detector was capable of measuring gamma radiation in quantities as low as 0.1 microCi (0.0037 MBq) per ml. Two patients (A and B) with endoscopically proven bile reflux, and three normal volunteers (C, D and E) underwent oesophageal manometry to map the position of the lower oesophageal sphincter (LOS). The gamma probe was passed via the nose, to a position in the gastric fundus, 5 cm below the LOS. Each subject was placed supine under a gamma camera (Siemens LFOV 37 ZLC head), centred on the epigastrium. A 4 mCi (148 MBq) dose of radiolabelled 99Tcm-HIDA was administered intravenously, and simultaneous internal/external scanning was performed for between 45 and 90 min. Internal gamma probe data was transferred by a screened cable to a Memolog 600 portable recorder, using a 5 s counting interval, and from the gamma camera to a Nodecrest Micas III computer, using a 15 s counting interval. Gamma camera counts from a region of interest over the fundus of the stomach were then correlated with counts from the internal probe using a linear regression analysis program on the Nodecrest. The internal gamma probe functioned well at body temperature in the acidic gastric environment. Radiolabelled bile refluxed into the stomach during HIDA scanning in three out of the five subjects (one patient and two normal volunteers). There was a strong correlation between internal and external gamma counts (A, r = +0.79; C, r = +0.53; E, r = +0.54; P greater than 0.01). In the other two cases, there was no bile reflux, but still a significant correlation between internal and external gamma counts (B, r = +0.89; D, r = +0.75; P greater than 0.01). The mean correlation coefficient for the series of five cases was +0.70. We conclude firstly that the newly developed internal gamma detector is capable of measuring the reflux of radiolabelled bile into the human stomach and, secondly, that bile reflux may occur in normal subjects as well as those with upper gastrointestinal pathology.

Topics: Aged; Ambulatory Care; Bile Reflux; Evaluation Studies as Topic; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radiometry; Radionuclide Imaging; Technetium Tc 99m Lidofenin

The authors proposed a method of cholescintigraphy with functional imaging reflecting RP distribution within the entire area in the field of vision of a gamma-chamber detector taking account of the type of motor activity of the gall bladder. This method was based on plotting an activity-time curve along the outer contour of a gall bladder image, the determination of moments of change in gall bladder motor activity on this curve, and the calculation of corresponding gradients of RP accumulation and clearance functions represented on an image where the color of each element was determined by a sign of the gradient and its intensity--by its absolute value. The use of this method in 92 patients made it possible to reveal conditions with possible B-bile reflux into the intrahepatic ducts, and to raise its diagnostic accuracy by 7% as compared to a routine analysis of activity-time curves by decreasing the number of false-negative results.

Topics: Adult; Bile Reflux; Biliary Tract Diseases; Female; Humans; Imino Acids; Male; Methods; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Gastric aspiration and HIDA scintigraphy have been compared to assess duodenogastric bile reflux. Gastric aspiration was performed on two separate occasions with a total examination time of 3 h. The highest 1-h output and the highest concentration of bile acids were recorded. HIDA scintigraphy was carried out for 90 min after an injection of 60 MBq 99mTc-dimethyl-iminodiacetic acid (HIDA). Forty-six patients with different gastrointestinal disorders were studied; 24 patients were positive and 13 negative in both tests. Accordingly, the methods agreed in 37 to 46 patients (80.4%). It is concluded that gastric aspiration is as reliable as HIDA scintigraphy to assess fasting bile reflux.

Topics: Adult; Aged; Bile Acids and Salts; Bile Reflux; Biliary Tract Diseases; Duodenum; Female; Gastric Juice; Humans; Imino Acids; Inhalation; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Respiration; Technetium Tc 99m Lidofenin

Hepatobiliary imaging after Whipple's operation provides information regarding the flow of bile. In the case presented there was jejunogastric bile reflux. This demonstrated the incompetence of the side to side jejunojejunostomy, which was surgically recommended to avoid bile reflux to the stomach. Jejunogastric bile reflux explains the patient's complaint of dyspepsia and occasional bilious vomiting in this case.

Topics: Bile Reflux; Biliary Tract; Duodenum; Humans; Imino Acids; Male; Middle Aged; Pancreatectomy; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Gastrectomy; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

In 5 patients with partial gastric resection and esophagitis, in whom esophageal pH metry was unable to demonstrate significant gastroesophageal reflux (GER), we administered i.v. 5 mCi (185 MBq) of 99mTc-HIDA, the patient lying under a computer-assisted LFOV gamma camera. When gallbladder image was evident, caerulein was administered i.v. at a physiologic dose in order to induce gallbladder contraction, and in the subsequent 45 min the patient was asked to perform a standard series of manoeuvres that increase the intraabdominal pressure (Valsalva, etc.) and favour GER. Scintigraphic images and time/activity curves obtained from areas of interest corresponding to gastric remnant and distal esophagus showed that at least one of these manoeuvres in each case was followed by the appearance of the radiocompound in the distal esophagus, indicating a 99mTc-HIDA-tagged bile GER. Consequently, we believe that HIDA-GER dynamic scintigraphy may be more useful than esophageal pH metry in demonstrating the biliary origin of an esophagitis.

Topics: Bile Reflux; Biliary Tract Diseases; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Bile Reflux; Biopsy; Endoscopy; Female; Gastrectomy; Gastric Juice; Humans; Hydrogen-Ion Concentration; Imino Acids; Male; Mass Screening; Middle Aged; Postoperative Complications; Precancerous Conditions; Radionuclide Imaging; Risk; Stomach Neoplasms; Technetium; Technetium Tc 99m Lidofenin

This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by 99mTc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative 99mTc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier weight loss. The enterogastric reflux indices of 10 asymptomatic control patients after Billroth II gastrectomy ranged from 4% to 45%. 99mTc HIDA scintigraphy is useful in evaluating patients before and after bile diversion surgery, and demonstrates the quantitative decrease in enterogastric reflux after such surgery.

Topics: Adult; Anemia, Hypochromic; Bile Reflux; Biliary Tract Diseases; Body Weight; Female; Gastrointestinal Hemorrhage; Humans; Imino Acids; Male; Middle Aged; Postgastrectomy Syndromes; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

We used a Tc-99m-labeled hepatobiliary agent to measure the partition of hepatic bile between gallbladder and intestine in sixteen normal patients and nine patients with cholelithiasis. In normal subjects, the fractions of the hepatic bile that flow into the gallbladder and the small intestine were widely variable, with mean values of 69 +/- 7% (s.e.) and 31 +/- 7% respectively. Bile reflux into the common hepatic duct was rare, occurring during the first 2/3 of the gallbladder ejection period and only when the ejection fraction was greater than 59%. The gallbladder's mean latent period, ejection period, ejection fraction, and ejection rate were 2 +/- 1 min, 11 +/- 1 min, 59 +/- 4%, and 5.9%/min respectively. In patients with cholelithiasis, the fraction of hepatic bile flowing into the gallbladder was normal, but the ejection fraction was significantly reduced (p less than 0.005). For an equivalent dose of cholecystokinin, the gallbladder in cholelithiasis is less responsive than in normal subjects.

Topics: Adult; Animals; Bile Reflux; Cholecystokinin; Cholelithiasis; Female; Gallbladder; Hepatic Duct, Common; Humans; Imino Acids; Male; Middle Aged; Rabbits; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Technology, Radiologic

A new method is described which allows simultaneous measurement of gastric emptying and duodenogastric reflux and avoids transpyloric intubation. After intragastric instillation of a liquid lipid meal in six healthy volunteers the fractional gastric emptying rate was 2.9 +/- 0.3 in the upright and 2.5 +/- 0.6 SEM X 10(-2)/min in the supine position, respectively (p greater than 0.5). The duodenogastric reflux rate (expressed as fraction of the intraduodenal amount of duodenal marker) was 0.30 (range 0.03-0.81) and 0.22 (0.01-0.55) X 10(-2)/min, respectively (p greater than 0.2). Atropine (40 micrograms/kg) decreased the supine gastric emptying rate to 1.1 +/- 0.2 (p less than 0.05) and increased the supine duodenogastric reflux rate to 2.74 (0.04-9.80) X 10(-2)/min (p less than 0.05). Fasting duodenogastric reflux rate was similar in the supine and upright position, 0.49 (0.04-0.89) and 0.42 (0.06-0.97) X 10(-2)/min, respectively (p greater than 0.5). Fractional gastric emptying rate was similar in 10 volunteers and 17 patients with type I gastric ulcer (2.1 +/- 0.4 vs 1.7 +/- 0.2 SEM X 10(-2)/min, p greater than 0.2). Their duodenogastric reflux rates were also similar, 0.65 (0.01-5.24) vs 1.10 (0.01-10.83) X 10(-2)/min (p greater than 0.5). We conclude therefore that (1) gastric emptying and both fasting and postprandial duodenogastric reflux are independent of the posture; (2) fasting and postprandial reflux are of similar magnitude; (3) atropine shows gastric emptying and increases duodenogastric reflux; and (4) patients with type I gastric ulcer have neither slowed gastric emptying nor increased duodenogastric reflux.

Topics: Adult; Aged; Atropine; Bile Reflux; Duodenal Diseases; Fasting; Female; Food; Gastric Acid; Gastric Emptying; Humans; Imino Acids; Male; Methods; Middle Aged; Posture; Stomach Diseases; Stomach Ulcer; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Duodenal Ulcer; Female; Humans; Imino Acids; Male; Technetium; Technetium Tc 99m Lidofenin

A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40--50 cm).

Topics: Bile Reflux; Biliary Tract Diseases; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Imino Acids; Postgastrectomy Syndromes; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Duodenum; Gastric Emptying; Gastrointestinal Motility; Humans; Imino Acids; Methods; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

The experiment consists in intravenous infusion of 99mTc-Hepatobida, fractioned aspiration of the gastric juice by means of a tube and measurement of radioactivity in the aspirated liquid. Patients are fasting for at least twelve hours and tests are started early in the morning. 5 mCi of 99mTc-Hepatobida are injected intravenously. Thereupon gastric juice is collected by means of a gastric tube every ten min during 90 min. Duodenogastric reflux is provoked by installing 100 ml of Intralipid. Sampling of gastric contents is continued as above. Radioactivities in the aspirate are compared in five patients before operation, after truncal vagotomy with pyloroplasty, after highly selective vagotomy without pyloroplasty and after highly selective vagotomy without pyloroplasty. There is no typical pattern for either type of operation. We suggest that motor antral activity is more important than pyloric function.

Topics: Bile Reflux; Gastrointestinal Motility; Humans; Imino Acids; Pylorus; Technetium; Technetium Tc 99m Lidofenin; Vagotomy; Vagotomy, Proximal Gastric