Journal Article

Prevalence and Demographic Associations of Delayed Gastric Emptying Scintigraphy While on Prescribed Opioid Medications: Is the 72-hour Opioid Withholding Time Adequate?

Harer, Kimberly, Lee, Allen, Amat, Louise, Baker, Jason, Hasler, William, Watts, Lydia

2018

Overview

Introduction: Opioid medications are an established cause of delayed gastric emptying. Given this known association, gastric emptying scintigraphy (GES) is typically performed after a 72-hour opioid withholding period to prevent detection of opioid-induced gastroparesis. It is unknown if opioids contribute to gastric emptying delay even when withheld for 72 hours. We reviewed a scintigraphy database to examine the associations of opioids on solid (GES-S) and liquid (GES-L) gastric emptying after a 72-hour withholding period. Methods: Retrospective analyses were conducted of GES results from November 2009 to August 2017 of patients with an active opioid prescription at the time of GES. Patients withheld opioids for 72 hours prior to GES testing. GES was performed after ingestion of dual-labelled meals (1 mCi 99mTc sulfur colloid in egg substitute/toast, 0.075 mCi 111In DTPA in water). Delayed GES-S was defined as greater than 10% retention at 4 hours post-meal ingestion. Delayed GES-L was defined as greater than 50% retention at 1 hour. Drug formulation, route of administration, and dosing (PRN vs scheduled) were recorded. Results: 1,417 patients were included in the analysis. The mean age was 48 + 16 years, and 71% were female. Delayed GES-S prevalence in patients with an active opioid prescription was 33.6%, versus a historical 23.4% institutional prevalence in an unselected population (p < 0.001). Delayed GES-L prevalence in patients with an active opioid prescription was 29.8%. Among oral opioid users, the prevalence of delayed GES-L was associated with increasing age (OR 1.01, p = 0.02) (Table 1). There was also a trend between increasing age and delayed GES-S, but statistical significance was not reached (p = 0.06). These findings were independent of opioid formulation, route of administration, or dosing schedule (PRN vs scheduled). Conclusion: Despite a 72-hour withholding period, opioid use is associated with an increased prevalence of delayed solid and liquid gastric emptying when compared to historical control data. The difference in prevalence of delayed gastric emptying between the opioid-user cohort and the historical control cohort suggest the standard 72-hour opioid withholding period may be insufficient in duration. These results should prompt further studies that investigate if the opioid withholding period should be extended beyond 72-hours to prevent detection of prolonged opioid-induced gastric neuromuscular dysfunction.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Gastroenterology / Narcotics / Scintigraphy