title: Objective assessment of delayed gastric emptying using gastric scintigraphy in post pancreaticoduodenectomy patients.
abstract: BACKGROUND
  No objective assessment of delayed gastric emptying is carried out in patients undergoing Whipple's procedure. All definitions and criteria along with evaluation of incidence of delayed gastric emptying are based on subjective assessment of the patient with clinical overview, so this study was carried out for an objective and accurate assessment of delayed gastric emptying in post Whipple's patients using gastric scintigraphy.
  
  
  METHODS
  Twenty-one patients undergoing Whipple's procedure performed by a single surgeon in a tertiary referral centre were included in the study. Gastric scintigraphy was performed preoperatively and on post-operative 10th and 21st days. Preoperative and post-operative gastric scintigraphy findings were used for the diagnosis of delayed gastric emptying and it was correlated with the incidence of clinical diagnosis of delayed gastric emptying.
  
  
  RESULTS
  Thirteen out of 21 patients had clinical delayed gastric emptying. When compared with clinical delayed gastric emptying, the sensitivity, specificity, positive and negative predictive values of post-operative 10th day gastric scintigraphy were 61.53, 100, 100 and 61.53%, respectively (P = 0.004). The sensitivity, specificity, positive and negative predictive values of post-operative 21st day gastric scintigraphy were 38.46, 100, 100 and 50%, respectively (P = 0.04). Reflux across the gastrojejunal anastomosis was noted in 28.5% on dynamic scintigraphy with the severity of clinical symptoms related directly with the degree of reflux. No correlation was seen between delayed gastric emptying and variables such as diabetes mellitus, hypertension and pancreaticojejunal anastomotic leaks.
  
  
  CONCLUSIONS
  Gastric scintigraphy may be used to diagnose delayed gastric emptying more objectively in post Whipple's patients.
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Avishek
authors.initials: A
authors.lastname: Samaddar
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Lileswar
authors.initials: L
authors.lastname: Kaman
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Dahiya
authors.affiliation: Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Anish
authors.initials: A
authors.lastname: Bhattachyarya
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Saroj Kant
authors.initials: SK
authors.lastname: Sinha
mesh_terms: D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013270:Stomach / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Whipple's pancreaticoduodenectomy procedure; delayed gastric emptying; gastric scintigraphy