Non-invasive Estimation of Duodenogastric Reflux Using Technetium-99m P-butyl-iminodiacetic Acid

Post-gastrectomy symptoms of dyspepsia, epigastric pain, nausea, and bilious vomiting have been ascribed to duodenogastric reflux. A noninvasive method, using the radiopharmaceutical technetium-99m p-butyl-iminodiacetic acid, has been developed to observe biliary excretion scintigraphically and to monitor its excretion. 10 controls and 45 patients after stomach operations were given the radiopharmaceutical intravenously and were scanned every 5 min for an hour, after which the site of the stomach was determined by asking the patient to drink technetium-99m in solution. Reflux was noted in 1 control, in 4 of 13 patients after highly selective vagotomy, in 8 of 17 patients following truncal vagotomy and pyloroplasty, and in all of 15 patients after gastrectomy. The mean quantities of reflux in these four groups were 5%, 3.75%, 12.4%, and 44%, respectively. The study confirms that post-gastrectomy patients are more prone to enterogastric reflux and suggests that this form of scintigraphy may produce valuable clinical information.