title: Effect of percutaneous endoscopic gastrostomy on gastrointestinal motility: evaluation by gastric-emptying scintigraphy.
abstract: OBJECTIVE
  Firstly, to assess the effect of percutaneous endoscopic gastrostomy (PEG) tube placement on gastric emptying, gastrointestinal (GI) tract motility and the rate of gastroesophageal reflux (GER). Secondly, to confirm whether correlations exist between drug absorption behaviour and GI tract motility using the combination method of absorption function analysis with the motility study.
  
  
  METHODS
  Subjects comprised 11 patients with neurological dysphagia. Gastric-emptying scintigraphy was performed both before PEG via nasogastric tube feeding and after PEG placement. After fasting for more than 8 h, each patient was administered 111 MBq of 99mTc-labelled diethylenetriaminepentaacetic acid (DTPA) with a 100 ml liquid meal via a nutrition tube. Dynamic imaging was performed immediately after administration of a radiolabelled liquid meal for a 1 h period and static imaging was performed after 1, 2, 3 and 6 h. Gastric emptying half-time (T50) was calculated in each patient, and GER ratio and GI transit rate were also evaluated. Simultaneously, we administered 10 mg of famotidine in six of the 11 patients and measured serum concentrations of famotidine at 0, 1, 2, 3 and 6 h. Using the time-concentration curve of famotidine, the maximum concentration of famotidine (Cmax) and area under the curve of famotidine (AUCf) were calculated for each patient.
  
  
  RESULTS
  In seven of 11 patients, T50 changed after PEG placement, but not significantly. The GER ratio was significantly decreased and complicated pneumonia improved after PEG placement. GI transit rate for each GI segment was unchanged after PEG placement. Significant linear correlations were identified between T50 and both Cmax and AUCf.
  
  
  CONCLUSIONS
  Gastric-emptying scintigraphy with Tc-DTPA was effective in the evaluation of GI transit before and after PEG, as well as in assessing GER. Motility and famotidine absorption were maintained after PEG placement. Significant linear correlations were found between T50 and both Cmax and AUCf. These findings suggest that drug absorption may have some relationship between T50. The result may be more reliable with a larger population.
authors.affiliation: Department of Radiology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan. hide.w@helen.ocn.ne.jp
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Wakamatsu
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nagamachi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Nishii
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Higaki
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kawai
authors.forename: Kiyohisa
authors.initials: K
authors.lastname: Kamimura
authors.forename: Seigo
authors.initials: S
authors.lastname: Fujita
authors.forename: Shigemi
authors.initials: S
authors.lastname: Futami
authors.forename: Shozo
authors.initials: S
authors.lastname: Tamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D005769:Gastrointestinal Motility; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011877:Radionuclide Imaging