Sana Munir Gill  ( Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore, Pakistan )
Mairah Razi  ( Department of Nuclear medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan )

Scintigraphic analysis of gastric motility uses the rate of gastric emptying by measuring radioactivity remaining in the stomach at pre-defined points in time. It helps to assess unresolved symptoms of functional gastrointestinal disorders such as gastroparesis. Delayed gastric emptying can occur in post-oesophagectomy patients. Squamous cell carcinoma of the esophagus is a common indication for oesophagectomy. In such patients presenting with post-prandial symptoms of bloating, nausea or vomiting, colloid scintigraphy can play a vital role in evaluation of their symptoms. We present an interesting image of a post-oesophagectomy patient with persistent gastric dilatation suspected of delayed gastric emptying

 

Keywords: Gastric emptying, Colloid scan, Esophagectomy, Squamous cell carcinoma

 

DOI: 10.47391/JPMA.23-38

 

 

A 38-year-old male with moderately differentiated squamous cell carcinoma (SCC) of mid-oesophagus underwent two cycles of neoadjuvant chemotherapy followed by radical radiotherapy and three-staged oesophagectomy. He had persistent gastric dilatation on CT and was referred for colloid gastric emptying study. Endoscopy showed normal patent anastomosis. Post-oesophagectomy delayed gastric emptying is experienced by many patients¹. Despite improvement in surgical interventions, its incidence is as high as 15-39%³ and can result due to anatomical or physiological changes in gastric conduit such as pyloric resistance and bilateral vagotomy². This can cause severe nutritional issues³. Dr. Griffith was the pioneer of using nuclear scan for gastric motility in 1966⁴.

Colloid scan was acquired after ingesting standard Tc99m-labelled meal. Planar images showed delayed gastric emptying. Radiotracer activity in the gastric pull-through on the right side of the chest showed slow transit into the intestine. Significant tracer retention was noted in the gastric pull-through at 4 hours on planar and SPECT/CT images. Gastric dilatation with air fluid levels and gastric luminal narrowing at the level of diaphragm was also seen. The gastric portion below the diaphragm was mildly dilated. Thus, in our patient delayed gastric emptying was a result of anatomical constriction at the site of diaphragmatic hiatus rather than the anastomotic site. After further assessment, the patient had gastric conduit dilatation.

 

References

 

1.      Frederick AB, Lorenz WR, Self S, Schammel C, Bolton WD, Stephenson JE, Ben-Or S. Delayed Gastric Emptying Post-Esophagectomy: A Single-Institution Experience. Innovations (Phila). 2020;15:547-554.

2.      Zhang R, Zhang L. Management of delayed gastric conduit emptying after esophagectomy. J Thorac Dis. 2019;11:302-307.

3.      Yang HC, Choi JH, Kim MS, Lee JM. Delayed Gastric Emptying after Esophagectomy: Management and Prevention. Korean J Thorac Cardiovasc Surg. 2020;53:226-232.

4.      Griffith GH, Owen GM, Kirkman S, Shields R. Measurement of rate of gastric emptying using chromium-51. Lancet. 1966;1:1244-5.