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

A new technique for the long-term ambulatory detection of enterogastric and nonacid gastroesophageal reflux has been conceived, developed, and validated. It is based on the use of a fiberoptic sensor that utilizes the optical properties of bile. In vitro studies have shown good precision, good stability, sensitivity of 2.5 mumol/liter bilirubin concentration, as well as a useful working range of 2.5-100 mumol/liter bilirubin concentration. In vivo studies have been performed in 29 subjects. Simultaneous gastric aspirations have allowed a comparison of fiberoptic system measurements both with spectrophotometric analysis and bile acid concentrations of corresponding gastric juice samples. Linear correlations were shown between fiberoptic assessment and both spectrophotometric and bile acid concentration findings (P < 0.01). Simultaneous assessment of reflux with the fiberoptic system and cholescintigraphy has shown a 92.9% concordance as regards the presence or absence of reflux. Present results imply that the fiberoptic system is an important tool for the understanding of the clinical relevance of enterogastric and nonacid gastroesophageal reflux.

Topics: Adult; Aged; Biliary Tract; Duodenogastric Reflux; Equipment Design; Evaluation Studies as Topic; Female; Fiber Optic Technology; Gastroesophageal Reflux; Gastrointestinal Contents; Humans; Imino Acids; Male; Middle Aged; Monitoring, Physiologic; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Lidofenin; Time Factors

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

Hepatobiliary scintigraphy with 99mTc-HIDA offers a noninvasive method to detect duodenogastric reflux. Biliary reflux was graded using the persistence rather than the intensity of the radioactive refluxate: Grade 0 was considered the absence of reflux, minimal reflux, or reflux in the first 10-15 min; Grade 1 was repetitive reflux lasting less than 10 min; Grade 2 was persistent reflux; and Grade 3 was reflux up to the esophagus. Twenty-five patients with foregut symptoms were studied and results were compared to 24-hr gastric pH monitoring. Scintigraphy and pH monitoring agreed in 15 out of 25 patients (60%), but no correlation was found with the endoscopic findings. The rationale for this approach is based on pathophysiologic evidence that damage to gastric and/or esophageal mucosa is mainly related to the prolonged contact time with duodenal contents. This technique seems to allow a complete functional evaluation of the esophagogastroduodenal tract without causing adjunctive irradiation or discomfort to the patient.

Topics: Adult; Aged; Duodenogastric Reflux; Female; Gastric Juice; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Imino Acids; Male; Middle Aged; Monitoring, Physiologic; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Time Factors

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

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: Gastric Juice; Gastroesophageal Reflux; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin