식도암 환자의 GET 영상 평가

문종운,이충운,서영덕,윤상혁,김용근,원우재,Moon, Jong Wun,Lee, Chung Wun,Seo, Young Deok,Yun, Sang Hyeok,Kim, Yong Keun,Won, Woo Jae 대한핵의학기술학회 2013 핵의학 기술 Vol.17 No.2

위배출 시간 측정(Gastric Emptying Time, GET)은 비침습적이고 정량적 평가 방법으로서 주로 내시경이나 방사선적 검사로 기계적 폐쇄가 없음이 확인된 위정체 증상을 보이는 환자를 검사한다. 이와 같은 일반적인 위배출 시간 측정 검사 외에 식도암 환자(식도 절제술을 시행한)를 대상으로 수술 직후와 1년 이상의 시간이 지난 후의 위배출 시간 측정 검사를 시행하여, 수술 후 흉강내에서 위장 기능의 평가 자료로서 위배출 시간 측정 검사의 유용성을 평가하고자 한다. 본원을 내원해서 식도 절제술을 시행한 환자 93명을 대상으로 위배출 시간 측정 검사를 수술 직후와 1년 이상의 시간이 지난 후에 두 번 시행하였다. 환자의 검사 전 준비사항으로는 12시간 이상 밤새 공복과 약재나 흡연을 중단 시켜야 하고 당뇨병 환자는 인슐린 주사 후 아침 일찍 검사하는 것이 이상적이다. 검사 방법은 유동식의 위배출 시간 측정은 예민도가 떨어지므로 시행하지 않고, 고형식의 위배출 시간 측정 방법으로 $^{99m}Tc-DTPA$로 표지된 레진이 들어간 계란찜, 그리고 김밥과 점성이 높은 발효유와 함께 먹은 후 입위 자세로 3시간 동안 측정하였다. 검사의 평가 방법은 위배출 곡선 상에서 위내 방사능치가 50%가 되는 시간, 즉 반감기(T1/2)를 구하였고, 반감기가 180분 이상시 지연 위배출, 180분 이내는 중등도, 삼킴과 동시에 소장으로 넘어가는 경우를 급속 위배출로 구분하였다. 일반적인 위배출 시간 측정 영상은 위의 전정부와 위저부가 강하게 나타나는 영상에서 시간이 지남에 따라 소장으로 넘어가는 영상이지만, 식도 절제술을 시행한 식도암 환자는 흉강쪽에 강한 집적 영상을 보였다. 수술 직후 반감기(T1/2)는 급속 위배출이 12.9%, 중등도 위배출이 52.7%, 지연 위배출이 34.4%로 나타났다. 이후 1년 이상의 시간이 흐른 뒤의 반감기 결과는 수술 직후 급속 위배출 환자 중 67%가 중등도 위배출로, 지연 위배출을 보였던 환자는 69%가 중등도 위배출로 나타났다. 중등도 위배출을 보였던 환자 중 급속 위배출 이나 지연 위배출로 나빠진 경우는 24%이다. 식도 절제술을 시행한 식도암 환자의 위배출 시간 측정 검사는 반감기(T1/2)가 급속 위배출 및 지연 위배출에서 시간이 지날수록 중등도 위배출로 변하는 소견을 보였다. 이는 주로 위를 보는 위배출 시간 측정 검사가 흉강내의 식도를 대신하는 위장 기능의 평가에도 유용하게 쓰일 수 있다는 것을 의미한다. 그리고 평가 기준을 세분화하고 검사의 시간 간격을 좁힌다면 좀 더 많은 정보와 분석으로 정확한 임상 진단과 평가가 이루어질 것으로 보인다. Purpose: Measure gastric emptying time (GET: Gastric Emptying Time) is a non-invasive and quantitative evaluation methods, mainly by endoscopic or radiological examination confirmed no mechanical obstruction in patients with symptoms of congestion is checked. Such tests are not common gastric emptying time measured esophageal cancer patients (who underwent esophagectomy) patients after surgery for gastric emptying time was measured test. And the period of time for more than one year after the gastric emptying time measurement was performed. By comparing the two kinds of tests in the chest cavity after surgery as the evaluation of gastrointestinal function tests evaluate the usefulness of GET, and will evaluate the characteristics of the image. Materials and Methods: 93 patients who underwent esophagectomy with gastric emptying time measurement of subject tests immediately after surgery and after 1 year or longer were twice. Preparation of the patient before the test is more than 12 hours of overnight fasting is important, in addition to the medicine or to stop smoking, and diabetes insulin injections should be early in the morning is ideal to test. Generally labeled with $^{99m}Tc-DTPA$ resin which is used to make steamed egg, seaweed and fermented milk with a high viscosity after eating, three hours in the standing position was measured. Evaluation of gastric emptying curves on the way intragastric radioactivity level by 50% the time (half-time [T1/2]) was calculated, based on the half-life was divided into three steps: over 180 minutes was defined as delayed gastric emptying, within 180minutes was defined as intermediate gastric emptying and when all the radioisotopes were dumped into the jejunum as soon as swallowed, was defined as rapid gastric emptying. Results: Gastric emptying time of a typical images stomach of antrum and fundus additional images appear stronger over time move on to the small intestine. but esophageal cancer who underwent esophagectomy side of the thoracic cavity showed a strong image. Immediately after surgery, the half-time (T1/2) of rapid gastric emptying appeared to 12.9%, intermediate gastric emptying appeared to 52.7%, delay gastric emptying appeared to 34.4%. After more than a year the results of the half-life after surgery, 67% of rapid gastric emptying to intermediate gastric emptying was changed, 69% of delay gastric emptying to intermediate gastric emptying changed. Intermediate gastric emptying worse in patients rapid gastric emptying and the delay gastric emptying is 24% in the case. Conclusion: Esophagectomy for esophageal cancer who underwent half-time measurement test (T1/2) rapid gastric emptying and delay gastric emptying are the result of the comparison over time, changes were observed intermediate gastric emptying. Mainly seeing of gastric emptying time measurement in the esophagus instead of thoracic cavity to check the evaluation of gastrointestinal function can be useful even means. And segmentation criteria and narrow time interval of checking if more accurate information and analysis of the clinical diagnosis and evaluation seems to be done.

위장 이식편을 이용한 식도 재건술에서 위장 배출 지연 현상의 가시화

전혜진,이재익,박희진,성재용 한국가시화정보학회 2009 한국가시화정보학회지 Vol.7 No.2

The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted. The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted.

Association between symptoms, quality of life and gastric emptying in dyspeptic patients

Fabien Wuestenberghs,Mathilde Juge,Chloé Melchior,Charlotte Desprez,Anne-Marie Leroi,Guillaume Gourcerol 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.4

Background/Aims Association between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is associated with specific symptoms and quality of life in dyspeptic patients. Methods We reviewed retrospectively gastric emptying measured by 13C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI. Results In our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6–8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples. Conclusions There is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.

Endoscopic Evaluation of Gastric Emptying and Effect of Mosapride Citrate on Gastric Emptying

정인수,김지현,이활윤,이상인,박효진 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.1

Purpose: Gastric emptying has been evaluated by scintigraphy in spite of its limitations of time consumption, cost,and danger of radioisotope. Endoscopy is a simple technique, however, its validation for gastric emptying and quantification of food has not yet been investigated. The aim of our study was to assess endoscopic gastric emptying compared with scintigraphy and radiopaque markers (ROMs) studies. We also investigated the effect of a single dose of mosapride on gastric emptying. Materials and Methods: Fifteen healthy volunteers underwent scintigraphy. Next day, subjects received a standard solid meal with ROMs and underwent endoscopy and simple abdomen X-ray after 3 hrs. After one week, the same procedure was repeated after ingestion of mosapride (5 mg for group 1, n = 8; 10 mg for group 2, n = 7) 15 min before the meal. Quantification of gastric residue by endoscopy was scored from 0 to 3, and the scores were added up. Results: All subjects completed the study without any complication. The gastric emptying rate [T1/2 (min)] was in normal range (65.6 ± 12.6 min). Endoscopic gastric emptying was correlated significantly with gastric clearance of ROMs (r = 0.627, p = 0.012). Endoscopic gastric emptying and gastric clearance of ROMs after administration of mosapride showed significant differences in the 10mg group (p < 0.05). Conclusion: Endoscopy can evaluate gastric emptying safely and simply on an outpatient basis. A 10 mg dose of mosapride enhanced gastric emptying, assessed by both endoscopy and ROMs.

Normal Solid Gastric Emptying Values Measured by Scintigraphy Using Asian-style Meal: A Multicenter Study in Healthy Volunteers

( Pataramon Vasavid ),( Tawatchai Chaiwatanarat ),( Pawana Pusuwan ),( Chanika Sritara ),( Krisana Roysri ),( Sirianong Namwongprom ),( Pichit Kuanrakcharoen ),( Teerapon Premprabha ),( Kitti Chunlert 대한소화기기능성질환·운동학회 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.3

Background/Aims To report gastric emptying scintigraphy, normal values should be established for a specific protocol. The aim of this study was to provide normal gastric emptying values and determine factors affecting gastric emptying using Asian rice-based meal in healthy volunteers. Methods One hundred and ninety-two healthy volunteers were included at 7 tertiary care centers across Thailand. Gastric emptying scintigraphy was acquired in 45 degree left anterior oblique view immediately after ingestion of a 267 kcal steamed-rice with technetium- 99m labeled-microwaved egg meal with 100 mL water for up to 4 hours. Results One hundred and eighty-nine volunteers (99 females, age 43 ± 14 years) completed the study. The medians (5-95th percentiles) of lag time, gastric emptying half time (GE T1/2) and percent gastric retentions at 2 and 4 hours for all volunteers were 18.6 (0.5-39.1) minutes, 68.7 (45.1-107.8) minutes, 16.3% (2.7-49.8%) and 1.1% (0.2-8.8%), respectively. Female volunteers had significantly slower gastric emptying compared to male (GE T1/2, 74 [48-115] minutes vs. 63 (41-96) minutes; P < 0.05). Female volunteers who were in luteal phase of menstrual cycle had significantly slower gastric emptying compared to those in follicular phase or menopausal status (GE T1/2, 85 [66-102] mintes vs. 69 [50-120] minutes or 72 [47-109] minutes, P < 0.05). All of smoking volunteers were male. Smoker male volunteers had significantly faster gastric emptying compared to non-smoker males (GE T1/2, 56 [44-80] minutes vs. 67 [44-100] minutes, P < 0.05). Age, body mass index and alcohol consumption habits did not affect gastric emptying values. Conclusions A steamed-rice with microwaved egg meal was well tolerated by healthy volunteers. Gender, menstrual status and smoking status were found to affect solid gastric emptying. (J Neurogastroenterol Motil 2014;20:371-378)

Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth-I anastomosis using circular stapler for early gastric cancer patients

Ki Han Kim,Min Chan Kim,Ghap Joong Jung 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.5

Purpose: Gastric surgery may potentiate delayed gastric emptying. Billroth I gastroduodenostomy using a circular stapler is the most preferable reconstruction method. The purpose of this study is to analyze the risk factors associated with delayed gastric emptying after radical subtotal gastrectomy with Billroth I anastomosis using a stapler for early gastric cancer. Methods: Three hundred and seventy-eight patients who underwent circular stapled Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer were analyzed retrospectively. One hundred and eighty-two patients had Billroth I anastomosis using a 25 mm diameter circular stapler, and 196 patients had anastomosis with a 28 or 29 mm diameter circular stapler. Clinicopathological features and postoperative outcomes were evaluated and compared between the two groups. Delayed gastric emptying was diagnosed by symptoms and simple abdomen X-ray with or without upper gastrointestinal series or endoscopy. Results: Postoperative delayed gastric emptying was found in 12 (3.2%) of the 378 patients. Among all the variables, distal margin and circular stapler diameter were significantly different between the cases with delayed gastric emptying and no delayed gastric emptying. There were statistically significant differences in sex, body mass index, comorbidity, complication, and operation type according to circular stapler diameter. In both univariate and multivariate logistic regression analyses, only the stapler diameter was found to be a significant factor affecting delayed gastric emptying (P = 0.040). Conclusion: In this study, the circular stapler diameter was one of the most significant predictable factors of delayed gastric emptying for Billroth I gastroduodenostomy. The use of a 28 or 29 mm diameter circular stapler rather than a 25 mm diameter stapler in stapled gastroduodenostomy for early gastric cancer can reduce postoperative delayed gastric emptying associated with anastomosic stenosis or edema with relative safety.

Correlation Between Gastric Emptying and Gastric Adaptive Relaxation Influenced by Amino Acids

( Masayuki Uchida ),( Orie Kobayashi ),( Chizuru Saito ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.3

Background/Aims Amino acids have many physiological activities. We report the correlation between gastric emptying and gastric adaptive relaxation using tryptophan and amino acids with a straight alkyl chain, hydroxylated chain, and branched chain. Here we sought to further clarify the correlation between gastric emptying and gastric adaptive relaxation by using other amino acids. Methods In Sprague-Dawley rats, gastric emptying was evaluated by a breath test using [1-¹³C] acetic acid. The expired ¹³CO₂ pattern, T_max, C_max, and AUC_120min values were used as evaluation items. Gastric adaptive relaxation was evaluated in a barostat experiment. Individual amino acids (1 g/kg) were administered orally 30 minutes before each breath test or barostat test. Results L-phenylalanine and L-tyrosine did not influence gastric emptying. All other amino acids, ie, L-proline, L-histidine, L-cysteine, L-methionine, L-aspartic acid, L-glutamic acid, L-asparagine, L-arginine, L-glutamine, and L-lysine significantly delayed and inhibited gastric emptying. L-Cysteine and L-aspartic acid significantly enhanced and L-methionine and L-glutamine significantly inhibited gastric adaptive relaxation. L-Phenylalanine moved the balloon toward the antrum, suggesting strong contraction of the fundus. T_max showed a significant positive correlation (r = 0.709), and C_max and AUC_120min each showed negative correlations (r = 0.613 and 0.667, respectively) with gastric adaptive relaxation. Conclusion From the above findings, it was found that a close correlation exists between gastric emptying and adaptive relaxation, suggesting that enhanced gastric adaptive relaxation inhibits gastric emptying. (J Neurogastroenterol Motil 2017;23:400-408)

흰쥐의 위(胃) 배출능(排出能)에 대한 반하사심탕(半夏瀉心湯)의 효능(效能)

이준석,김진성,류봉하,윤상협,Lee, Joon-Suk,Kim, Jin-Sung,Ryu, Bong-Ha,Yoon, Sang-Hyub 대한한방내과학회 2006 大韓韓方內科學會誌 Vol.27 No.2

Backgrounds & Objectives: Banhasasimtang granule(BHSST) has been used for the treatment of functional dyspepsia regarded as one of the gastric dysmotility disease. but its mechanisms of action are not well known yet: So we investigated the effects of BHSST on gastric emptying and its mechanisms of action in rats. Methods: Gastric emptying was measured by glass beads(1mm in diameter) expelled from the stomach for 60 min after administration of normal saline(NS) or BHSST 31mg/kg or 93mg/kg in rats. And by the same method gastric emptying was measured after administration of NS or BHSST 93mg/kg in rats treated with atropine sulfate(1mg/kg, s.c.), quinpirol HCI(0.3mg/kg, i.p.), NAME(NG-nitro-L-arginine methyl ester, 75mg/kg, s.c.) or cisplatin(10mg/kg, i.p.) to make delayed gastric emptying. Results: BHSST 93mg/kg improved gastric emptying more than NS or BHSST 31mg/kg(p=0.016). Under the delayed gastric emptying, BHSST 93mg/kg improved gastric emptying in the group treated with NAME$(5.00{\pm}3.101\;vs\;9.00{\pm}3.51,\;p\;=0.046)$, but aggravated it With atropine sulfate$(5.71{\pm}3.45\;vs\;2.57{\pm}1.62,\;p\;=0.050)$ and cisplatin$(12.7{\pm}2.29\;vs\;8.57{\pm}5.06,\;p\;=0.072)$. Conclusions: BHSST improves the gastric emptying through cholinergic and 5-hydroxytryptamine 3 receptors. Especially it is effective to improve gastric emptying delayed by NAME. So we expect that it would be effective in functional dyspepsia with impaired reservoir functions such as gastric adaptive relaxation.

Do HbA1C Levels Correlate With Delayed Gastric Emptying in Diabetic Patients?

( Shilpa Reddy ),( Karishma Ramsubeik ),( Kenneth J Vega ),( Justin Federico ),( Carlos Palacio ) 대한소화관운동학회 2010 Journal of Neurogastroenterology and Motility (JNM Vol.16 No.4

Background/Aims Gastroparesis is characterized by delayed gastric emptying without obstruction. Diabetes is frequently associated with poor glycemic control and delayed gastric emptying. Gastric emptying scintigraphy (GES) is the standard for measuring gastric emptying. Serum hemoglobin A1C (HbA1C) measures prolonged glycemic control with normal as <7% glycated. To date, no correlation of serum HbA1C level with gastric emptying, demonstrated by GES, in diabetics has been performed. The aim of the present investigation is to determine if a relationship exists between serum HbA1C levels and gastric emptying, assessed by GES, in diabetics. Methods All diabetics, having both GES and serum HbA1C level within 3 months from July 1, 2003-June 30, 2008 were eligible for study. Demographic data collected included gender, age and ethnicity. Abnormal gastric emptying was defined as T½>120 minutes and serum HbA1C as percent glycated. Results Nuclear Medicine GES database review revealed 431 examinations performed during the study interval. A total of 181 were not eligible due to the following: 29 duplicates, 22 diabetes not documented and 130 without HbA1C levels, resulting a study group of 250 cases. No significant correlation was observed between gastric emptying time, HbA1C or age. Among patients with HbA1C ≥7%, HbA1C was inversely related to age with a coefficient of correlation of r=-0.175 (p=0.038). Conclusions There is no correlation observed between gastric emptying time, using GES, and serum HbA1C levels. In diabetics, serum HbA1C is not as important as daily glycemic control regarding gastric emptying. (J Neurogastroenterol Motil 2010;16:414-417)

기능성 소화불량중에서 위 배출능 검사

이종채(Zhong Chai Lim),나용호(Yong Ho Nah) 대한내과학회 1994 대한내과학회지 Vol.47 No.2

N/A Objectives: Though the patients with functional dyspepsia suffer from variable symptoms, no satisfactory explanation for their complaints can be found. The 5 categories of functional dyspepsia were suggested by the working party on the management of dyspepsia in 1987. The cause of functional dyspepsia is obscure but many reports have shown that about 50% patients with functional dyspeopsia had delayed gastric emptying. There- fore, we evaluated the gastric emptying rate in the subtypes of functional dyspepsia. Method: The gastric emptying study was performed in 30 healthy volunteers and 50 patients with functional dyspepsia. The gastric emptying curves were divided into a lag phase and an emptying phase using the dual phase model. Lag phase was determined by three techniques: 1) inspection of the emptying curve; 2) time to a 2% decrease in stomach activity; and 3) the time of visual appearance of duodenal activity. The patients with functional dyspepsia were categorized on the basis of predominat symptoms as: dysmotility-like dyspepsia, ulcer-like dyspepsia, gastro-esophageal reflux-like dyspepsia, idiopathic dyspepsia, and aerophagia. Results: 1) Functional dyspepsia patients were categorized on the basis of predominant symptoms as: dysmotility-like dyspepsia (n=24), ulcer-like dyspepsia (n=15), gastro-esophageal reflux-like dyspepsia (n=8), idiopathic dyspepsia (n=3). 2) Length of lag perod and half emptying time of solids in normal volunteers were 6.5±4.5 min (95the percentile=15 min) and 98±20 min (95th percentile=120 min). 3) Delayed gastric emptying was confirmed in 38% of patients and only in 3 patients lag period was delayed. There was no correlation between delayed gastric emptying and symptom categories. Conclusion: As above results about 50% patients with functional dyspepsia are categorized as dysmotility-like dyspepsia. There is no difference in the frequency of delayed gastric emptying among the symptom categories and about 38% patients with functional dyspepsia have delayed gastric emptying.