**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF003'|0]] 
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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Prof G Avery  |  ARSAC Licence Holder  |    |  2025-01-14  |

====== REF003 - Gastric Emptying ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer.

=====  Description  =====
Nuclear Medicine gastric emptying studies are the only satisfactory method of quantitatively measuring the rate of gastric emptying of solid meals. The patient eats a meal containing <sup>99</sup>Tc<sup>m</sup> labelled colloid. The percentage retention of the radioactive meal within the stomach at different time points (i.e. 1, 2, 3 and 4 hours post ingestion) is evaluated  and compared to normal values for each time point. The meal used at this centre is scrambled egg and two slices of toast. If the patient is allergic to egg, a porridge meal is used instead. Finally, if the patient cannot consume a solid meal, a liquid meal consisting of radioactive water is used. 


[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='99mTc-24-92'  AND date('now')<=expirydate  ORDER BY expirydate|0]]

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/employers_procedures/drl_database.db|
SELECT nuclide AS Nuclide, pharmaceutical_form AS "Pharmaceutical Form",  
local_drl AS "Local DRL (MBq)" FROM drls INNER JOIN nuclides ON drls.nuclide_id=nuclides.id 
WHERE drls.id=6|0]]

^Typical Radiation Dose (mSv)  |0.9 | 

===== Staff Entitled to Refer =====
  * Any clinician holding a current valid medical qualification currently employed in Secondary care.
  * Referrals from Primary Care will be accepted if the investigation has been suggested by a Consultant Radiologist in a report from a previous investigation or following discussion with a Consultant Radiologist or secondary care specialist.  Details of such suggestions or discussions should be included on the request form.

===== Supplementary Drugs =====
  * None 

===== Contraindications =====
^Allergies |• Eggs.  \\ • Bread.  |
^Medical Conditions  | • Diabetic patients require caution when fasting  |

===== Patient Preparation =====
^Diet | • Fast for a minimum of 4 hours [(E. Dore, M. Hall. Guideline for Gastric Emptying. Report March 2015, BNMS.)] (preferably overnight with the study scheduled for early morning)[(#1)]. Note that patients should take nothing by mouth (i.e. no food or drink) [(#1)] but may take medications as advised by the referring physician as normal (NB tablet medications can be taken with some water) [(T. L. Abell et al. Consensus Recommendations for Gastric Emptying Scintigraphy: A Joint Report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol; 2008; 36: 44-54.)].\\ • Nothing other than the test meal should be eaten for the duration of the study[(#2)]. |||
^Other | • Refrain from smoking on the morning of the test[(#3)].\\ • For pre-menopausal women, book an appointment during the first 10 days of their menstrual cycle to avoid the effects of hormonal variation on gastrointestinal motility[(#1)][(#3)]. For women with irregular menstrual cycles, the appointment can be booked at any day of the month. |||
^Medications  | • Stop medications that interfere with gastric emptying rate (see list below) two days before the study [(K. J. Donohoe et al. Procedure guideline for adult solid-meal gastric-emptying study 3.0*. Society of Nuclear Medicine; 2009)]  unless the test is performed to assess the efficacy of the drug (**//NB The referring physician will determine what medications are to be continued prior to the study//**). \\ • Medications should not be resumed until the end of the study.|||
^:::| **Insulin-dependent diabetic patients need to bring their glucose monitors and insulin with them.** \\ Prior to the time of meal ingestion, ask the patient to check their serum glucose level and record the value. If the serum glucose level is found to be:\\ •  <15.3 mmol/l (or 275 mg/dl), perform the study as normal;\\ • >15.3 mmol/l and the patient has already had their insulin, reschedule the study.\\ •  >15.3 mmol/l and the patient has not had their insulin, ask the patient to self-administer the insulin and re-measure the serum glucose level 30 minutes later. If it is now found to be <15.3 mmol/l, then perform the study; otherwise, reschedule the study for a later date[(#3)]. |||
^:::^ Group of Medication ^ Medication ^ Proprietary |
^:::| Prokinetic Agents | Metoclopramide | Maxalon \\ MigraMax |
^:::|:::| Domperidone | Motilium | 
^:::|:::| Erythromycin| Erymax \\ Erythrocin \\ Erythroped \\ Erythroped A |
^:::|:::| Tegaserod | Not available in the UK |
^:::| Antispasmodic Agents | Atropine | Non-proprietary |
^:::|:::| Dicycloverine | Merbentyl \\ Kolanticon |
^:::|:::| Hyoscine Butylbromide | Buscopan |
^:::|:::| Hyoscine Hydrobromide | Joy rides \\ Kwells \\ Scopoderm TTS patches |
^:::|:::| Alverine Citrate | Spasmonal |
^:::|:::| Mebervine Hydrochloride | Colofac |
^:::|:::| Peppermint Oil | Colpermin \\ Mintec |
^:::| Opiate Analgesics |Codeine | Non-proprietary |
^:::|:::| Dihydrocodeine |:::|
^:::|:::| Morphine |:::|
^:::|:::| Diamorphine |:::|
^:::|:::| Pethidine |:::|

===== Clinical Indications =====

^  Investigation  |
|Assessment of gastric emptying following peptic ulcer surgery  |
|Investigation of suspected dumping of food or diarrhoea  |
|Diabetic patients with upper GI symptoms  |
|Possible gastroparesis or dumping syndrome  |
|Possible gastric reflux  |
|Endoscopy negative dyspepsia  |
|Persistent symptoms after gastric surgery  |
|Follow up scans to assess response to therapy  | 





~~DISCUSSION~~