- 期刊
Scintigraphic Gastroesophageal Reflux Test in Patients Fed by Percutaneous Endoscopic Gastrostomy-Correlation with 24-Hour Esophageal pH Monitoring
核子醫學閃爍造影術用來診斷內視鏡經皮胃造口術患者胃食道逆流－以二十四小時食道酸度測量來評估
摘要
Gastroesophageal (GE) scintigraphy has been described as a simple method to detect gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG). Our objective was to evaluate the accuracy of the scintigraphic method in comparison to 24-h esophageal pH monitoring. Methods: Thirty-five patients with neurological dysphagia who required PEG feeding were studied. Each subject received 300m1 of 5% glucose water solution labeled 300μ Ci Tc-99m DTPA through the PEG tube in a supine position and an abdominal binder was applied to increase the pressure from 0 to 100 mmHg. Fifteen randomly selected patients underwent a repeated scintigraphic study on a separate day to evaluate the reproducibility. Twenty-four hour esophageal pH monitoring was positioned 5 cm above the lower esophageal sphincter under a standard meal on the same day of scintigraphy. Results. The percent time of 24-h with pH＜4 was significantly higher in the scintigraphic positive group than in the scintigraphic negative group (22.36%±3.2%vs.3.1%±0.83%, p＜0.001). When a cutoff value of 4% of total percent time with pH＜4 was selected, the sensitivity was 71% and specificity was 93%; when a cutoff value of 14% was selected, the sensitivity was 100%, and the specificity was 76%. The reproducibility of scintigraphy was 87%. Conclusion: Scintigraphy is a simple, feasible and relatively specific tool for detecting GE reflux. Although its clinical application as a screening test for reflux may be limited by its low sensitivity, it may be a sensitive test in patients with prolonged GE reflux, for whom pulmonary aspiration is risky.
並列摘要
Gastroesophageal (GE) scintigraphy has been described as a simple method to detect gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG). Our objective was to evaluate the accuracy of the scintigraphic method in comparison to 24-h esophageal pH monitoring. Methods: Thirty-five patients with neurological dysphagia who required PEG feeding were studied. Each subject received 300m1 of 5% glucose water solution labeled 300μ Ci Tc-99m DTPA through the PEG tube in a supine position and an abdominal binder was applied to increase the pressure from 0 to 100 mmHg. Fifteen randomly selected patients underwent a repeated scintigraphic study on a separate day to evaluate the reproducibility. Twenty-four hour esophageal pH monitoring was positioned 5 cm above the lower esophageal sphincter under a standard meal on the same day of scintigraphy. Results. The percent time of 24-h with pH＜4 was significantly higher in the scintigraphic positive group than in the scintigraphic negative group (22.36%±3.2%vs.3.1%±0.83%, p＜0.001). When a cutoff value of 4% of total percent time with pH＜4 was selected, the sensitivity was 71% and specificity was 93%; when a cutoff value of 14% was selected, the sensitivity was 100%, and the specificity was 76%. The reproducibility of scintigraphy was 87%. Conclusion: Scintigraphy is a simple, feasible and relatively specific tool for detecting GE reflux. Although its clinical application as a screening test for reflux may be limited by its low sensitivity, it may be a sensitive test in patients with prolonged GE reflux, for whom pulmonary aspiration is risky.