Purpose or Case Report: Esophageal transit scintigraphy (ETS) complements anatomic imaging studies such as contrast esophagography for the evaluation of esophageal motility disorders. This noninvasive technique provides reliable and reproducible functional data that is useful in the evaluation of both primary and secondary esophageal motility disorders. This image-rich exhibit will provide an overview of this examination using representative examples of ETS studies in children, including technical considerations, imaging features in various disorders, and pitfalls in intepretation, with correlative fluoroscopic and/or CT images.
Methods & Materials: ETS is performed with posterior acquisition and a low-energy high resolution collimator during swallowing of a small amount of ^99mTc-sulfur colloid mixed with liquid (milk, formula, or 5% dextrose water), semi-solid, or solid food. Dynamic images are obtained at 2 sec./frame for 100 sec., with delayed static images performed when there is large amount of residual esophageal activity. Xiphoid markers, ⁵⁷Co transmission images, and lateral or oblique delayed static images may be helpful for troubleshooting. Evaluation of time activity curves with quantitation based on regions of interest is standard. For this exhibit, interesting and instructive cases were selected from the 75 ETS studies performed in patients less than or equal to 21 years of age at our institution between January 2006 and October 2016.
Results: 1. Pharyngeal or esophageal retention, aspiration, and reflux may be detected on visual inspection of dynamic images.
2. Characteristic patterns of abnormal transit are seen in nutcracker esophagus, scleroderma, achalasia, and diffuse esophageal spasm.
3. ETS is helpful for evaluating esophageal/conduit function of patients who have had tracheoesophageal fistula repair, patients with strictures, and those who have had caustic ingestions or other esophageal injuries.
4. ETS could be performed before and after clinical interventions to assess the efficacy of therapy.
5. Correlation with anatomic imaging studies, when available, adds key information.
Conclusions: ETS is a low-dose, rapid, and simple examination that does not require sedation. Quantitative and qualitative data about esophageal function complements information obtained from anatomic imaging studies, endoscopy, and esophageal manometry in pediatric patients with esophageal dysmotility.