title: Gastroparesis in children: the benefit of conducting 4-hour scintigraphic gastric-emptying studies.
abstract: OBJECTIVE
  Scintigraphic gastric emptying study (GES) is the criterion standard for diagnosis of gastroparesis. Adult studies demonstrated that extending GES to 4 hours increases its ability to diagnose delayed gastric emptying. Most pediatric centers assess GES up to 2 hours postmeal. The aim of the present study was to assess the effect of extending GES from 2 to 4 hours in evaluation of children with suspected gastroparesis.
  
  
  METHODS
  We conducted a chart review of all children who had a 4-hour GES with standard radiolabeled solid meal in 2009-2010. Results of GES at 1, 2, and 4 hours were compared. Patients were diagnosed as having gastroparesis using adult criteria: if gastric retention of meal was >90%, 60%, and 10% at 1, 2 and 4 hours, respectively. A telephone survey assessed GES time at top 20 pediatric gastroenterology centers in the United States. Cost of evaluation of patients diagnosed as having gastroparesis was estimated. Full-time equivalents of nuclear medicine technicians and number of nuclear medicine studies done at Ann & Robert H. Lurie Children's Hospital of Chicago from 2007 to 2010 were examined.
  
  
  RESULTS
  A total of 71 patients (32 boys, average age 10.8 years) were studied. Sixty-two percent (n=44) children had abnormal GES; 23% (8/35) of them who had normal values at 2 hours had abnormal GES at 4 hours (P<0.0001). Twenty-eight percent of patients had delayed GES at 1 hour: all persisted to have abnormal GES at 2 and 4 hours. Cost of evaluation of a child for gastroparesis was $9014. Only 5 of the top 20 pediatric gastroenterology centers in the United States conducted 4-hour GES. Transitioning from 2 hours to 4 hours only required scheduling adjustments and did not result in limitation in the number of scheduled patients.
  
  
  CONCLUSIONS
  Extending GES to 4 hours results in a considerable increase in diagnosis of gastroparesis.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Ashish
authors.initials: A
authors.lastname: Chogle
authors.forename: Miguel
authors.initials: M
authors.lastname: Saps
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D042241:Early Diagnosis; D005260:Female; D005746:Gastric Emptying; D005762:Gastroenterology; D018589:Gastroparesis / Q000000981:diagnostic imaging* / Q000191:economics / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D010372:Pediatrics; D019518:Postprandial Period; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011877:Radionuclide Imaging / Q000191:economics; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013997:Time Factors; D014481:United States; D000078329:Workforce; D055815:Young Adult