Assessing the Clinical Value of 2-h Versus 4-h Gastric Emptying Scintigraphy in Pediatrics: A Systematic Review and Meta-Analysis

Introduction: The gold-standard diagnostic test for gastroparesis is gastric emptying scintigraphy (GES). Although a 4-h GES is recommended in adult guidelines, no similar guidelines exist in the pediatric population, with many hospitals utilizing a 2-h scan to reduce radiation exposure and save time.

Methods: We performed a systematic review and meta-analysis to evaluate differences in the diagnosis of gastroparesis during 2-h versus 4-h GES. Four databases were systematically searched for articles reporting results of GES at both the 2- and 4-h time points in a pediatric population. Outcomes included the proportion of patients with gastroparesis at 2- and 4-h and the number of patients with differing transit status (normal or abnormal) from 2- to 4-h. Meta-analyses were conducted utilizing a random effects model. Heterogeneity among studies was assessed utilizing the I² statistic.

Key results: A total of 344 records were identified, of which 9 articles met inclusion criteria. Of these, six articles were included in the meta-analysis. The pooled proportion of patients with alterations in gastric transit between 2 and 4 h was 0.2 (95% CI: 0.11 to 0.30). Overall, the extended 4-h scan captured an additional 10% of patients with gastroparesis. There was significant heterogeneity among the studies (I² = 91.8%, p < 0.001), likely due to differences in GES protocol and patient samples.

Conclusions and inferences: The 4-h GES offers a higher diagnostic yield in pediatric patients compared to a 2-h study, despite heterogeneity in existing research. Further prospective studies are necessary to further quantify this advantage.