Gastric Scintigraphy as a Bridge Between Objective and Clinical Evaluation of Delayed Gastric Emptying Following Pancreatic Surgery—A Pilot Study

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INTRODUCTION: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy, occurring in up to two-thirds of patients. Although rarely life-threatening, DGE prolongs hospitalization and increases healthcare costs. The International Study Group of Pancreatic Surgery (ISGPS) definition enables retrospective grading but lacks objective physiological assessment. This pilot study evaluated the feasibility and clinical relevance of standardized postoperative gastric scintigraphy. METHODS: Six patients undergoing pancreatoduodenectomy between January and May 2025 received one or two standardized liquid gastric emptying scintigraphies on postoperative days (POD) 4-6 and 10-13. Quantitative analysis included half-emptying time (T½) and residual activity (RA%) at 30 and 60 min. Findings were correlated with ISGPS-defined DGE. RESULTS: Eleven scintigraphic examinations were performed. Clinically relevant ISGPS Grade B/C DGE occurred in two patients and was associated with persistently elevated RA% at 60 min and prolonged T½ on early scintigraphy. Two additional patients showed scintigraphic abnormalities without meeting clinical DGE criteria, without confirmed outcome-level consequences. CONCLUSIONS: Standardized gastric scintigraphy may provide an objective and reproducible method for evaluating DGE after pancreatoduodenectomy and may complement clinically based ISGPS definitions.

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