technetium-tc-99m-sulfur-colloid and Esophageal-Achalasia

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

Topics: Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagus; Gallium Radioisotopes; Gastroesophageal Reflux; Humans; Muscular Dystrophies; Organotechnetium Compounds; Radionuclide Imaging; Rhenium; Sodium Pertechnetate Tc 99m; Stomach; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

The authors hypothesized that radionuclide esophageal transit (RET) studies performed in the upright position and aided by gravity would provide better objective evaluation of achalasia than supine scanning and would correlate better with the degree of symptomatic relief after treatment. Radionuclide esophageal transit studies were prospectively performed in both the supine and upright positions in four symptomatic patients before treatment, after simple dilation, and after pneumatic dilation in patients who did not respond to simple dilation. After simple dilation, two patients reported near resolution of symptoms. Supine RET revealed little improvement, but upright esophageal emptying was markedly improved at 2, 5, and 10 minutes. In the two patients who had no relief after simple dilation. RET failed to show improvement while they were in either the supine or the upright position. These patients subsequently underwent pneumatic dilation that resulted in resolution of symptoms and marked improvement in upright RET only. In the supine position, the esophageal emptying at 2 minutes in the four patients after successful dilation improved from 0% baseline to a mean of 14% (+/- 18%). However, in the upright position, esophageal emptying improved from 3% (+/- 3%) to 73% (+/- 17%) and better correlated with symptomatic relief. The difference in improvement in esophageal emptying in the upright versus the supine position was statistically significant (P = 0.0033). The authors conclude that only upright esophageal emptying provides objective evidence that correlates well with symptomatic relief.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Dilatation; Esophageal Achalasia; Esophagus; Female; Humans; Male; Middle Aged; Peristalsis; Posture; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

To determine the patterns of esophageal motility found in patients with Chagas' disease.. Clinical, manometric, and scintigraphic data were obtained from 43 subjects with positive serological tests for Chagas' disease and nondilated esophagus and 10 patients with Chagasic megaesophagus.. Twenty (46.5%) of the seropositive subjects with nondilated esophagus were asymptomatic, and 23 (53.5%) had dysphagia, but only 12 (27.9%) had persistent dysphagia, a feature typical of Chagasic megaesophagus; only two (4.6%) had chest pain. Manometric findings within the seropositive group were: normal motility in 16 subjects, peristaltic multipeaked contractions in three, aperistalsis of the esophagus with relaxing lower esophageal sphincter in nine, and aperistalsis with nonrelaxing lower esophageal sphincter in 15 subjects. All of 10 megaesophagus patients had aperistalsis of the esophagus plus nonrelaxing lower esophageal sphincter. Scintigraphy was as sensitive as manometry in detecting esophageal dysmotility, but the erect scintigraphy was abnormal in subjects with complete aperistalsis only.. In Chagas' disease, megaesophagus appears to be a disorder at the most severe end of a spectrum encompassing classical achalasia and its milder variants. Other esophageal motility disorders are rare, but normal esophageal function is common.

Topics: Adolescent; Adult; Aged; Chagas Disease; Deglutition Disorders; Esophageal Achalasia; Esophageal Motility Disorders; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Peristalsis; Technetium Tc 99m Sulfur Colloid

In two patients with achalasia we found intermittent, complete lower oesophageal sphincter (LES) relaxations at manometric evaluation. These patients had no weight loss, minimal oesophageal dilation, lower LES pressure and faster radionuclide oesophageal emptying when compared with other achalasia patients. Concurrent performing of radionuclide oesophageal emptying and manometry showed that the complete relaxations (CRs) were too short and functionally unsuccessful. Our findings suggest that these patients may be at an earlier disease stage and that intermittent CRs of LES may occasionally occur in achalasia.

Topics: Barium Sulfate; Deglutition; Esophageal Achalasia; Esophagogastric Junction; Humans; Male; Manometry; Middle Aged; Muscle Relaxation; Peristalsis; Pressure; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Adult; Esophageal Achalasia; Gastrointestinal Transit; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Radionuclide esophageal transit (RET) is a noninvasive method of studying esophageal function. The purpose of this study was to evaluate RET as a screening test for motility disorders in symptomatic patients. Esophageal manometry and RET were performed in 16 volunteers and in 34 patients who were referred for motility evaluation. Each RET study consisted of two swallows of labeled water with the patient in the supine position under a gamma camera. Six patients had achalasia, two had scleroderma, two had diffuse esophageal spasms, and five had a nonspecific motor disorder. In each case the RET time was prolonged (greater than 15 s). Ten patients had reflux esophagitis; two of these had both abnormal manometry results and prolonged RET times. There were nine patients with upper gastrointestinal tract symptoms but normal manometry results and the RET test was positive in two patients. There were no false-negative RET results. The agreement between the RET and manometry results in this series was 96% (48/50). This preliminary experience suggests that RET is as sensitive as manometry for identifying motility disorders.

Topics: Adult; Aged; Esophageal Achalasia; Esophageal Diseases; Esophagitis, Peptic; Female; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Muscle, Smooth; Peristalsis; Radionuclide Imaging; Reference Values; Scleroderma, Systemic; Spasm; Technetium Tc 99m Sulfur Colloid

Topics: Deglutition Disorders; Esophageal Achalasia; Esophagus; Gastroesophageal Reflux; Humans; Posture; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

The authors present their experience with the radionuclide esophagogram. Cases illustrating achalasia, diffuse esophageal spasm, nutcracker esophagus, oculopharyngeal muscular dystrophy, reflux esophagitis, gastroesophageal reflux, Barrett's esophagus, hiatal hernias, pharyngoesophageal diverticulum, and malignant tumors of the esophagus are included. The radionuclide esophagogram proved to be a useful procedure in the diagnosis and follow-up of many esophageal diseases.

Topics: Adenocarcinoma; Adult; Aged; Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Reference Values; Spasm; Stomach Neoplasms; Technetium Tc 99m Sulfur Colloid

For detailed examination of the esophageal transit of a swallowed radioactive liquid bolus, three computer-based techniques have been developed: (a) analysis of time-activity curves with decomposition into rapid and residual components, yielding the mean transit time for the former and the residual fraction for the latter; (b) reduction of dynamic image sequences to single condensed images, facilitating subjective assessment; and (c) tracking of the centroid of radioactivity, permitting quantification of retrograde motion. Studies were performed on 12 normal subjects and on six patients with motility disorders. Elevated residual fractions were observed in all the patients, and an abnormal degree of retrograde motion in two. Two normal and two abnormal studies exemplify the variety of patterns observed in condensed images.

Topics: Adult; Computers; Deglutition; Esophageal Achalasia; Esophageal Diseases; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Male; Mathematics; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

We measured quantitative esophageal transit, expressed as percentage of esophageal retention, before and after pneumatic dilatation in two patients with achalasia. In the sitting position they ingested a 500 ml liquid meal containing 500 muCi technetium Tc 99m sulfur colloid. Radioactivity counts of the entire esophagus were plotted at five-minute intervals for 30 minutes. In five normal control subjects the esophagus essentially cleared in less than one minute. Both patients with achalasia had definite retention 30 minutes before dilatation and had quantitative improvement after dilatation. Radionuclide scintigraphic esophageal transit probably correlates better than other parameters with the physiologic degree of obstruction in achalasia.

Topics: Adult; Dilatation; Esophageal Achalasia; Esophagus; Evaluation Studies as Topic; Humans; Male; Manometry; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors