Multicenter validation of a shortened gastric-emptying protocol

Matthieu Pelletier-Galarneau, Oyebola O. Sogbein, Xuan Pham, Jason Hao, Jenna Le, Mark D. Strober, Michael L. Middleton, Janusz Kikut, Leonard M. Freeman, Lionel S. Zuckier

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Gastric emptying scintigraphy is considered to be the gold standard for detection of gastroparesis and other disorders of gastric motility; Society of Nuclear Medicine and Molecular Imaging guidelines are predicated on imaging over a period of 4 h, which is inconvenient for patients. Bonta et al. introduced 2-h criteria, which served to shorten the protocol in most patients, with negligible loss of accuracy. We have evaluated the Bonta criteria in a larger multicenter trial encompassing 4 academic institutions. Methods: Retrospective data from 4 academic medical centers were aggregated; 431 patients were included, 105 (24.4%) of whom demonstrated delayed gastric emptying defined by 4-h gastric retention of more than 10%. Bonta criteria (retention . 65% is considered abnormal and , 45% normal; otherwise, proceed to complete examination) were applied to the 2-h data. Sensitivity, specificity, accuracy, and resource use for the Bonta method were calculated. Results based on standard 4-h solid gastric emptying, performed according to current Society of Nuclear Medicine and Molecular Imaging guidelines, served as the gold standard. Results: Retention of 10% or less was achieved by 6, 77, 215, and 326 patients at 1, 2, 3, and 4 h, respectively. At 2 h, 261 of 431 patients (60.6%) had gastric retention of less than 45%, which according to Bonta would be classified as normal; 62 (14.4%) had gastric retention of more than 65%, which would be classified as delayed emptying; and 108 (25.1%) had intermediate values requiring further imaging through 4 h. The Bonta criteria yielded a sensitivity, specificity, and accuracy of 92.4%, 96.9%, and 95.8%, respectively, superior to any single cutoff point applied to the 2-h values. The criteria resulted in falsenegative results in 8 (1.9%) patients, 6 of whom were borderlinepositive at 4 h (gastric retention of 11%-14%). Using the Bonta criteria, 74.9% of studies would be terminated by 2 h, decreasing total camera use by 15.7%, from 1,768 to 1,490 images, and the average study duration would be reduced by 20.6%, from 3.1 to 2.5 h. Conclusion: In a multicenter cohort, use of the Bonta criteria shortened the duration of studies in most patients, resulting in an effective compromise between reduced resource use, improved patient convenience, and preserved accuracy.

Original languageEnglish (US)
Pages (from-to)873-876
Number of pages4
JournalJournal of Nuclear Medicine
Issue number6
StatePublished - Jun 1 2015


  • Bonta criteria
  • Gastric emptying
  • Tougas protocol

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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