Considerations and Indications for Gastric Emptying Scintigraphy in Lung Transplant Patients

Document Type : Original Article

Authors

1 Temple University Hospital Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Philadelphia, PA USA

2 Temple University Hospital Department of Gastroenterology, Philadelphia, PA USA

3 Department of Biostatistics, Temple University Hospital, Philadelphia, PA USA

Abstract

Objective(s): Gastroparesis is a complication following lung transplantation. This study aimed to assess the prevalence of gastroparesis in patients with lung transplants undergoing solid phase gastric emptying scintigraphy (GES). Specifically, we investigated which type of lung transplant is more susceptible to gastroparesis and whether timing of GES post-transplantation impacts diagnosis of severe gastroparesis.
Methods: This retrospective analysis included lung-transplant recipients between January 2008 and February 2024, who underwent GES. Patients received a standardized egg sandwich labeled with 500 uCi Technetium-99m sulfur colloid. GES results were compared to normal values for percentages retained at 2- and 4-hours post-meal.
Results: Among 485 lung-transplant recipients, 111 (50% male; mean age 63 years) underwent posttransplant GES. Gastroparesis was diagnosed in 23% of lung transplant recipients during the study period. Of those who underwent GES, 67% exhibited delayed gastric emptying, with 38 patients (34%) demonstrating severe retention (>30% at 4 hours). Delayed gastric emptying rates were highest in bilateral lung transplant recipients (73%), followed by left (66%) and right (56%) lung transplant recipients. Timing of GES beyond 6 months or one-year post-transplant did not significantly increase the incidence of delayed gastric emptying (p>0.05). There was no significant difference in proportion of patients with delayed gastric emptying when patients were stratified by gender and age.
Conclusions:  Our findings suggest that laterality of lung transplant does not influence risk of delayed gastric emptying. Moreover, early evaluation of gastrointestinal symptoms with GES did not impact the severity or rate of gastroparesis. We recommend routine screening with GES for symptomatic lung transplant recipients, irrespective of transplant timing, to facilitate timely management and reduce post-operative complications associated with gastroparesis.

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Main Subjects

References

  1. Leard LE, Holm AM, Valapour M, Glanville AR, Attawar S, Aversa M, et al. Consensus document for the selection of lung transplant candidates: an update from the International Society for Heart and Lung Transplantation. The Journal of Heart and Lung Transplantation. 2021; 40(11):1349-79.
  2. Roy SB, Elnahas S, Serrone R, Haworth C, Olson MT, Kang P, et al. Early fundoplication is associated with slower decline in lung function after lung transplantation in patients with gastroesophageal reflux disease. The Journal of thoracic and cardio-vascular surgery. 2018; 155(6): 2762-71.
  3. Ciriza-de-los-Ríos C, Canga-Rodríguez-Valcárcel F, de-Pablo-Gafas A, Castel-de-Lucas I, Lora-Pablos D, Castellano-Tortajada G. Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection? Revista Española de Enfermedades Digestivas. 2018; 110(6): 344-51.
  4. Kayawake H, Chen-Yoshikawa TF, Motoyama H, Hamaji M, Nakajima D, Aoyama A, et all. Gastrointestinal complications after lung transplantation in Japanese patients. Surgery today. 2018; 48: 883-90.
  5. D–Ovidio F, Mura M, Ridsdale R, Takahashi H, Waddell TK, Hutcheon M, Hadjiliadis D, Singer LG, Pierre A, Chaparro C, Gutierrez C. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. American journal of transplantation. 2006; 6(8):1930-8.
  6. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Official journal of the American College of Gastroenterology| ACG. 2013; 108(1): 18-37.
  7. Berkowitz N, Schulman LL, McGregor C, Markowitz D. Gastroparesis after lung transplantation: potential role in post-operative respiratory complications. Chest. 1995; 108(6): 1602-7.
  8. Filichia LA, Baz MA, Cendan JC. Simultaneous fundoplication and gastric stimulation in a lung transplant recipient with gastroparesis and reflux. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2008; 12(3):303.
  9. Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in under-standing and treatment. Gut. 2019; 68(12): 2238-50.
  10. Rappaport JM, Raja S, Gabbard S, Thuita L, Sanaka MR, Blackstone EH, et al. Endoscopic pyloromyotomy is feasible and effective in improving post–lung transplant gastroparesis. The Journal of Thoracic and Cardiovascular Surgery. 2022; 164(3): 711-9.
  11. Ichkhanian Y, Hwang JH, Ofosu A, Li AA, Szvarca D, Draganov PV, et al. Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience. Endoscopy International Open. 2022; 10(06):E832-9.
  12. Hirji SA, Gulack BC, Englum BR, Speicher PJ, Ganapathi AM, Osho AA, et al. Lung transplantation delays gastric motility in patients without prior gastrointestinal surgery-a single‐center experience of 412 consecutive patients. Clinical Trans-plantation. 2017; 31(10): e13065.
  13. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Journal of nuclear medicine technology. 2008; 36(1):44-54.
  14. Campbell I. Chi‐squared and Fisher–Irwin tests of two‐by‐two tables with small sample recommendations. Statistics in medicine. 2007; 26(19): 3661-75.
  15. Blackett JW, Benvenuto L, Leiva-Juarez MM, D'Ovidio F, Arcasoy S, Jodorkovsky D. Risk Factors and Outcomes for Gastroparesis After Lung Transplantation. Dig Dis Sci. 2022; 67(6):2385-2394.
  16. Rentz AM, Kahrilas P, Stanghellini V, Tack J, Talley NJ, De La Loge C, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Quality of Life Research. 2004; 13:1737-49.
  17. Huang IH, Schol J, Khatun R, Carbone F, Van den Houte K, Colomier E, et al. Worldwide prevalence and burden of gastroparesis‐like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroentero-logy and Motility (ESNM) consensus on gastroparesis. United European Gastro-enterology Journal. 2022; 10(8): 888-97.
  18. Wohler A, Evans SR. Laparoscopic esophagomyotomy with dor fundoplication. Surgical Pitfalls E-Book: Prevention and Management. 2008; 28: 187.
  19. Sodhi SS, Guo JP, Maurer AH, O'Brien G, Srinivasan R, Parkman HP. Delayed gastric emptying after combined heart and lung transplantation. J Clin Gastroenterol. 2002; 34(1):34-9.
  20. Burlen J, Chennubhotla S, Ahmed S, Landes S, Ramirez A, Stocker AM, et al. Investigating defects of esophageal motility in lung transplant recipients. Gastro-enterology research. 2022; 15(3): 120.
  21. D–Ovidio F, Mura M, Ridsdale R, Takahashi H, Waddell TK, Hutcheon M,et al. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. American journal of transplantation. 2006; 6(8): 1930-8.
  22. Robertson AG, Ward C, Pearson JP, Small T, Lordan J, Fisher AJ, Bredenoord AJ, Dark J, Griffin SM, Corris PA. Longitudinal changes in gastrooeso-phageal reflux from 3 months to 6 months after lung transplantation. Thorax. 2009; 64(11):1005-7.
  23. Patti MG, Vela MF, Odell DD, Richter JE, Fisichella PM, Vaezi MF. The intersection of GERD, aspiration, and lung transplantation. Journal of Laparo-endoscopic & Advanced Surgical Techniques. 2016; 26(7):501-5.
  24. Basseri B, Conklin JL, Pimentel M, Tabrizi R, Phillips EH, et al. Esophageal motor dysfunction and gastroeso-phageal reflux are prevalent in lung transplant candidates. The Annals of thoracic surgery. 2010; 90(5):1630-6.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 13, Issue 1
January 2025
Pages 53-61

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