A new approach to scintigraphic evaluation of gastric tube emptying following subtotal esophagectomy

Standard scintigraphy of the alimentary tract cannot currently adequately evaluate functional changes in patients with esophagectomy and gastric reconstruction. We suggest two modifications of image analysis which improve the clinical value of transit scintigraphy in these patients. The modifications are illustrated in the case of a patient who was evaluated nine months after transthoracic esophagectomy and reconstruction with a gastric tube. Transit scintigraphy was performed with a radioactively labeled solid test meal. For better spatial differentiation, the lungs were also marked with radioactivity at the end of the examination. The digital scintigraphic data were processed with a self-developed computer program that allows three-dimensional visualization based on the different count ratio within the region of interest. In the presented case, the gastric tube was positioned completely within the chest and showed a rapid accumulation of the radioactive labeled test meal within its lower third, which acted as a reservoir. The interposed gastric tube emptied exponentially. Emptying was markedly accelerated compared to the gastric emptying of healthy volunteers. The evaluation of the gastric tube transit pattern is greatly improved by three-dimensional visualization and marking of the lungs, which allows precise topographical assignment. This modified scintigraphic examination is also applicable for other surgical reconstruction techniques following esophagectomy.