Byline: Ashwani. Sood, Sanjay. Gambhir, Deepa. Singh, K. Kumar, Ashwin. Parihar, Subhash. Kheruka, Veeresh. Dube, Satyawati. Deswal
Background/Aims: Esophageal transit scintigraphy (ETS) is a useful tool for evaluating esophageal motility disorders, although conflicting results are seen due to lack of ideal bolus. Semisolid/solid boluses have shown superiority over liquid boluses, and the present study aims to establish the utility of in-house-prepared bolus in normal volunteers and its comparison with liquid bolus. Materials and Methods: Thirty-three healthy volunteers were selected for ETS with in-house-prepared semisolid bolus jelly containing99mTc-sulfur colloid. Dynamic studies were acquired in anterior projection with single swallow for both supine and sitting positions. T90% esophageal emptying time (EET) was calculated for whole and three equally divided segments of esophagus and also done with liquid bolus on different day. Results: The median value of EET for semisolid bolus for whole esophagus in sitting and supine positions was 11.7 s (interquartile range [IQR]: 8.0-16.7) and 17.7 s (IQR: 12.0-33.0). EET of liquid bolus for whole esophagus in sitting and supine positions was 9.3 s (IQR: 8.0-13.3) and 13.0 s (IQR: 9.7-25.0), respectively. Significantly different EET for whole esophagus and lower one-third esophagus between sitting and supine positions was seen for semisolid (whole esophagus;P = 0.003, lower one-third esophagus; P = 0.025) and liquid boluses (whole esophagus; P = 0.032, lower one-third esophagus; P = 0.016). Comparing EET using semisolid and liquid boluses, only lower one-third esophagus in supine position showed significant difference (P = 0.033). Conclusions: In-house-prepared semisolid radiolabeled jelly is inexpensive, easy to prepare with good radiolabeling. Condensed dynamic images from semisolid bolus were better, sharper, and reproducible in comparison to liquid bolus without fragmentation. This study standardized semisolid bolus and verified its suitability for clinical use.
Functional symptoms such as heartburn, epigastric pain, and dysphagia caused by gastrointestinal motility disorders are often ignored despite their common occurrence in the general population. The physicians' awareness for the symptoms related to the underlying gastrointestinal dysmotility affords the successful evaluation and treatment of the patients with possible esophageal motor disorders. Apart from clinical history, a variety of methods are employed to diagnose the esophageal motility disorders (EMDs). However, with the exception of radionuclide scintigraphy, majority of methods are invasive/nonphysiological in nature. Esophageal manometry is considered to be gold standard, which provides indirect assessment of peristalsis, but its major drawback is limited availability, less acceptability to the patients due to invasive nature, and requirement of intubation which itself is an abnormal stimulant in the physiological evaluation of esophageal motility.
Esophageal transit scintigraphy (ETS), since its inception, has seen a number of modifications in the initial scintigraphic procedure in the form of quantitative parameters and functional imaging, or both, for studying the normal esophageal motility and its alteration in EMD., The utility of ETS has been extensively reported in different EMDs. Moreover, this technique has shown the possibility to measure the outcome of any therapeutic intervention. It seems to be useful when esophageal manometry is not tolerated or unavailable, or with equivocal or...