Temple University Hospital Philadelphia, Pennsylvania
Alexandra G. Selby, MD1, Ho-Man Yeung, MD1, Bhishak Kamat, MD1, Simin Dadparvar, MD1, Alyssa Goldbach, DO1, Daohai Yu, PhD, MS2, Xiaoning Lu3, Henry P. Parkman, MD, FACG1, Alan Maurer, MD, MS1; 1Temple University Hospital, Philadelphia, PA; 2Temple University School of Medicine, Philadelphia, PA; 3Temple University, Philadelphia, PA
Introduction: A small bowel transit study (SBT) evaluates the accumulation of radiolabeled meal in the terminal ileum (TI) and/or colon 6 hours after ingestion. Anatomic information is limited, often requiring that patients return for confirmatory imaging the next day. Given this inconvenience, a high nutrient liquid meal (Boost) can be given to promote passage of the radiolabeled meal into the colon to enhance visualization; however, the utility of this method is unclear. The primary aim of this study was to quantitatively determine if the administration of Boost at 6 hours facilitates visualization of the TI in equivocal cases, producing a definitive study result. Methods: This retrospective study included 117 patients undergoing SBT studies from 2/2017 to 9/2019. Two board-certified nuclear medicine radiologists independently evaluated all images (pre-Boost and post-Boost) as equivocal or definitive (i.e. normal or abnormal motility). Mutually agreed upon equivocal pre-Boost cases were included in post-Boost analysis. Post-Boost images were obtained 20 minutes after Boost administration. Any discordance was adjudicated by a third reader. The Pearson-Clopper exact method was used to calculate binomial confidence intervals for proportions. The Fisher exact test was employed to test associations between two categorical variables. Results: Of the included patients (71.8% female, median age 42.0 years) that underwent SBT studies, 37 of 117 were equivocal cases pre-Boost (31.6%, 95% CI=23.3%-40.9%) compared to 12 of 117 (10.3%, 95% CI=5.4%-17.2%) equivocal cases post-Boost. One case was excluded in subsequent analysis after adjudicator determination. Of the remaining 36 equivocal cases who received Boost, 25 (69.4%, 95% CI=51.9%-83.7%) had a definitive result after Boost, while 11 (30.6%, 95% CI=16.4%-48.1%) remained equivocal. IBS, gastroparesis, and non-early satiety cases appear to remain equivocal even after having received Boost (% equivocal: 100% vs. 24.2%, 43.5% vs. 7.7%, 41.7% vs. 8.3% compared to their counterpart; p=0.023, 0.031, 0.059, respectively). Discussion: The number of equivocal SBT cases was significantly decreased after administration of Boost at 6 hours, with a majority of cases converting to a definitive result. This suggests that some patients can complete the study without the need for repeat imaging. Boost seemed to be less effective for IBS, gastroparesis, and non-early satiety cases. Future studies exploring the cost-efficiency of using Boost should be considered.
Disclosures: Alexandra Selby indicated no relevant financial relationships. Ho-Man Yeung indicated no relevant financial relationships. Bhishak Kamat indicated no relevant financial relationships. Simin Dadparvar indicated no relevant financial relationships. Alyssa Goldbach indicated no relevant financial relationships. Daohai Yu indicated no relevant financial relationships. Xiaoning Lu indicated no relevant financial relationships. Henry Parkman indicated no relevant financial relationships. Alan Maurer indicated no relevant financial relationships.