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

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

Conventional methods for exploration of the esophagus (radiology and fibroscopy) are not sufficiently sensitive to provide a precise diagnosis of minor lesions. New techniques have been developed that enable improved evaluation of the physiopathology of gastro-esophageal reflux and other esophageal motor disorders. These include esophageal manometry, pH monitoring, the association of these two procedures, and finally scintigraphy. Manometry is the most effective method of assessing esophageal motility, and it can assist in the diagnosis of motor disorders related to reflux, of dyskinesias such as in mega-esophagus, and of collagen diseases. The most reliable method for diagnosing gastro-esophageal reflux is by means of pH monitoring. More detailed physiological and physiopathological data can be obtained by combining the two investigational methods. Scintigraphy can sometimes determine the responsibility of pulmonary disorders in the development of reflux.

Topics: Collagen Diseases; Diverticulum, Esophageal; Esophageal Diseases; Esophagogastric Junction; Esophagus; Humans; Hydrogen-Ion Concentration; Manometry; Muscular Diseases; Pressure; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

We combined edrophonium provocative testing with the technique of radionuclide oesophageal transit (RET) in 30 consecutive patients with non-cardiac chest pain (NCCP) and 12 controls. The oesophageal transit time of aqueous technetium-99m sulfur colloid was determined before and after intravenous infusion of 80 micrograms/kg edrophonium chloride (ED). Patient symptoms during provocative RET (P-RET) were recorded. Thirteen (43%) of the patients had abnormal study results, whereas all control subjects had normal results. Three groups considered abnormal were observed: (a) in two patients (6%), the pain was reproduced and transit pre- and post-ED administration was prolonged (greater than 15 s); (b) in six patients (20%), the pain was reproduced, but transit was normal pre- and post-ED; (c) in five patients (17%), transit pre- and post-ED was prolonged, but no pain was reproduced. In five patients (17%), ED prolonged the transit time greater than 15 s without pain, but the baseline transit was normal. Transit time was measurable in 23 patients. Mean pre-ED transit time was 10.2 +/- 7.4 s (mean +/- SD) and post-ED, 12.4 +/- 8.0 s (P = 0.3). We conclude that ED has no significant effect on transit time, and the pain induced by ED rarely correlates with an abnormal transit; P-RET provides additional information to baseline RET, increasing sensitivity, and may be a useful screening method in the evaluation of patients with NCCP.

Topics: Chest Pain; Edrophonium; Esophageal Diseases; Esophageal Motility Disorders; Esophagus; Female; Humans; Male; Middle Aged; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The whole digestive tract is one of the sites most involved in diabetic autonomic neuropathy. The aim of this work was to validate the clinical usefulness of oesophageal scintigraphy in the early detection of this complication of diabetes. Eighty-one diabetic patients without oesophageal symptoms were studied by solid meal scintigraphic test (SMST) and 35 out of them also by liquid meal scintigraphic test (LMST). As controls, 20 normal volunteers were studied by LMST and 14 by SMST. Forty-seven diabetics studied by SMST were also evaluated by cardiovascular tests (CT) and for the presence of retinopathy and peripheral neuropathy. The most statistically significant difference between diabetics and controls was found at 75s with SMST. SMST results showed a statistically significant correlation with CT. No correlation was found with the presence of retinopathy or peripheral neuropathy. We conclude that SMST is a useful, safe, low-cost diagnostic tool in the detection of diabetic autonomic neuropathy.

Topics: Adult; Aged; Autonomic Nervous System Diseases; Diabetic Neuropathies; Esophageal Diseases; Female; Humans; Male; Middle Aged; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Eighteen asymptomatic alcoholics, half with neuropathy, were studied within 3 days of drinking to evaluate the frequency, nature, and underlying causes of esophageal dysmotility. Ten were restudied after a month of sobriety. The mean lower esophageal sphincter pressure and esophageal contraction amplitude in alcoholics were significantly higher than controls. Radionuclide esophageal emptying was slower than controls. Abnormal motility studies included 9 patients with nutcracker esophagus and 5 patients with nonspecific motor disorder. After 1 mo of abstinence, 5 of 6 patients with nutcracker esophagus and one with nonspecific motor disorder became normal. Lower esophageal sphincter pressure and esophageal contraction amplitude also returned to normal. These abnormal findings were independent of neuropathy. One patient who had normal manometry and emptying had esophagitis. We demonstrated that esophageal dysfunction is common in alcoholics, even in the absence of esophagitis and neuropathy, suggesting that these do not play a major role in esophageal dysmotility. Nutcracker esophagus is a reversible and common manometric finding in asymptomatic alcoholics.

Topics: Adult; Alcoholism; Deglutition; Esophageal Diseases; Esophagogastric Junction; Esophagus; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Peristalsis; Technetium Tc 99m Sulfur Colloid

"Nutcracker" esophagus is a syndrome consisting of chest pain and/or dysphagia with elevation of the mean distal esophageal contractile pressure amplitude (MDA) (greater than 120 mm Hg). Its existence as a disorder of esophageal function and the proper manometric diagnostic criteria have been debated. A correlative study of radionuclide esophageal scintigraphy (RES) and manometry was performed in 31 patients with this manometric diagnosis. RES results were abnormal in 13 of 16 (81%) patients with an MDA above 150 mm Hg, and in only three of 15 (20%) patients with an MDA below this level. There was a significant difference in RES parameters (mean transit time and percentage emptying) between these two groups. Repeat manometric and RES studies showed considerable variability, but only RES showed a significant correlation between baseline and repeat studies. RES confirms a functional disorder in a subgroup of patients with the manometric diagnosis of nutcracker esophagus and supports a change in the manometric criteria for diagnosis of this disorder to an MDA above 150 mm Hg.

Topics: Chest Pain; Deglutition Disorders; Esophageal Diseases; Esophagus; Humans; Manometry; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Radionuclide esophageal scintigraphy (RES) and manometry were used for prospective evaluation of esophageal involvement and disease severity in 11 patients (nine women and two men; median time since diagnosis, 1 year) with progressive systemic sclerosis (PSS). Quantitation of RES included calculation of the percentage of emptying at 30 seconds, while manometry provided measurements of proximal, distal, and lower esophageal sphincter (LES) pressures. The findings of both RES and manometry were abnormal in all 11 patients. There was a high correlation between the percentage of emptying and either distal esophageal pressure (r = .86, P less than .01) or LES pressure (r = .79, P less than .01). No significant correlation was found between the percentage of emptying and proximal esophageal pressure (r = .28, P = .39). RES is a safe, simple procedure that is readily accepted by patients and can be used in place of manometry for the detection and staging of esophageal involvement in PSS.

Topics: Adult; Aged; Esophageal Diseases; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Peristalsis; Radionuclide Imaging; Scleroderma, Systemic; Technetium Tc 99m Sulfur Colloid; Time Factors

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

The clinical and investigative features of eight patients with attacks of epigastric pain believed due to a hypertensive lower esophageal sphincter (LES) are described. Radionuclide esophageal transit studies were normal in all but one patient. Two patients had positive acid perfusion studies. Only three had an abnormal baseline esophageal manometry, but after small intravenous doses of pentagastrin all subjects experienced their presenting pain coincident with increases in LES pressure ranging from 75 to 140 mmHg. Five patients eventually required surgical myotomy of the LES, but pain relief which was immediate and complete in all proved permanent in only one. Two of the operated patients continued to experience severe attacks of pain refractory to medical therapy. The diagnosis of a hypertensive LES is best made by pentagastrin stimulation of the sphincter, but cutting the sphincter may not cure the patient.

Topics: Adolescent; Adult; Diagnosis, Differential; Esophageal Diseases; Esophagogastric Junction; Female; Humans; Male; Manometry; Pentagastrin; Radionuclide Imaging; Spasm; Technetium Tc 99m Sulfur Colloid

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases.

Topics: Barium Sulfate; Deglutition Disorders; Endoscopy; Esophageal Diseases; Esophagus; Fiber Optic Technology; Heartburn; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Manometry; Medical History Taking; Pain; Peristalsis; Technetium Tc 99m Sulfur Colloid; Thorax

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

The past decade has witnessed an exponential growth of knowledge about upper gastrointestinal motility. The elucidation of the clinical problems is based on remarkable morphophysiologic, clinical, diagnostic, and pharmacotherapeutic advances. New approaches rely on a more sensitive application of manometric evaluation which has allowed identification of more subtle abnormalities of motility, as well as appreciation of the role of scintigraphic studies to measure transit through the esophagus, combined with the standard use of the cine-esophagogram modified to assess a solid bolus. New techniques to evaluate gastric motility include myoelectric gastrography and administration of isotope-labeled meals. These advances have been enhanced by the advent of prokinetic therapeutic agents, such as metoclopramide and domperidone. Evaluation of intestinal motility involves the use of intraluminal pressure sensing catheters, as well as methods to measure transit times. The standard hydrogen breath test as a noninvasive study of small intestinal transit time has been supplemented by an isotope-labeled liquid meal. Identification of clinical states with delayed and rapid small bowel transit times will have therapeutic implications in the future.

Topics: Breath Tests; Cineradiography; Deglutition Disorders; Esophageal Diseases; Esophagus; Gastric Emptying; Gastrointestinal Motility; Humans; Hydrogen; Intestine, Small; Manometry; Radionuclide Imaging; Spasm; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Adult; Child; Deglutition; Esophageal Diseases; Esophagus; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Infant; Mathematics; Pressure; Radiography; Radionuclide Imaging; Sulfur; Technetium; 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

Topics: Acute Disease; Cholecystitis; Esophageal Diseases; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Imino Acids; Indium; Leukocytes; Meckel Diverticulum; Organotechnetium Compounds; Radioisotopes; Radionuclide Imaging; Stomach Diseases; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Technology, Radiologic

Topics: Adolescent; Adult; Aged; Esophageal Diseases; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid