title: Multicenter validation of a shortened gastric-emptying protocol.
abstract: Gastric emptying scintigraphy is considered to be the gold standard for detection of gastroparesis and other disorders of gastric motility; Society of Nuclear Medicine and Molecular Imaging guidelines are predicated on imaging over a period of 4 h, which is inconvenient for patients. Bonta et al. introduced 2-h criteria, which served to shorten the protocol in most patients, with negligible loss of accuracy. We have evaluated the Bonta criteria in a larger multicenter trial encompassing 4 academic institutions.
  
  
  METHODS
  Retrospective data from 4 academic medical centers were aggregated; 431 patients were included, 105 (24.4%) of whom demonstrated delayed gastric emptying defined by 4-h gastric retention of more than 10%. Bonta criteria (retention > 65% is considered abnormal and < 45% normal; otherwise, proceed to complete examination) were applied to the 2-h data. Sensitivity, specificity, accuracy, and resource use for the Bonta method were calculated. Results based on standard 4-h solid gastric emptying, performed according to current Society of Nuclear Medicine and Molecular Imaging guidelines, served as the gold standard.
  
  
  RESULTS
  Retention of 10% or less was achieved by 6, 77, 215, and 326 patients at 1, 2, 3, and 4 h, respectively. At 2 h, 261 of 431 patients (60.6%) had gastric retention of less than 45%, which according to Bonta would be classified as normal; 62 (14.4%) had gastric retention of more than 65%, which would be classified as delayed emptying; and 108 (25.1%) had intermediate values requiring further imaging through 4 h. The Bonta criteria yielded a sensitivity, specificity, and accuracy of 92.4%, 96.9%, and 95.8%, respectively, superior to any single cutoff point applied to the 2-h values. The criteria resulted in false-negative results in 8 (1.9%) patients, 6 of whom were borderline-positive at 4 h (gastric retention of 11%-14%). Using the Bonta criteria, 74.9% of studies would be terminated by 2 h, decreasing total camera use by 15.7%, from 1,768 to 1,490 images, and the average study duration would be reduced by 20.6%, from 3.1 to 2.5 h.
  
  
  CONCLUSIONS
  In a multicenter cohort, use of the Bonta criteria shortened the duration of studies in most patients, resulting in an effective compromise between reduced resource use, improved patient convenience, and preserved accuracy.
authors.affiliation: The Ottawa Hospital, Division of Nuclear Medicine, Ottawa, Ontario, Canada mattgalarneau@gmail.com.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Pelletier-Galarneau
authors.affiliation: The Ottawa Hospital, Division of Nuclear Medicine, Ottawa, Ontario, Canada.
authors.forename: Oyebola O
authors.initials: OO
authors.lastname: Sogbein
authors.affiliation: The Ottawa Hospital, Division of Nuclear Medicine, Ottawa, Ontario, Canada.
authors.forename: Xuan
authors.initials: X
authors.lastname: Pham
authors.affiliation: University of Vermont Medical Center, Burlington, Vermont.
authors.forename: Jason
authors.initials: J
authors.lastname: Hao
authors.affiliation: Montefiore Medical Center, Bronx, New York; and.
authors.forename: Jenna
authors.initials: J
authors.lastname: Le
authors.affiliation: Baylor Scott & White Health, Central Texas, Temple, Texas.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Strober
authors.affiliation: Baylor Scott & White Health, Central Texas, Temple, Texas.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Middleton
authors.affiliation: University of Vermont Medical Center, Burlington, Vermont.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kikut
authors.affiliation: Montefiore Medical Center, Bronx, New York; and.
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Freeman
authors.affiliation: The Ottawa Hospital, Division of Nuclear Medicine, Ottawa, Ontario, Canada.
authors.forename: Lionel S
authors.initials: LS
authors.lastname: Zuckier
mesh_terms: D000046:Academic Medical Centers; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards; D005188:False Negative Reactions; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D012372:ROC Curve; D011877:Radionuclide Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
keywords: Bonta criteria; Tougas protocol; gastric emptying