Variation of Stomach Shapes in Gastric Emptying Scintigraphy: Correlation With Gastric Emptying Results, Body Weight, and Symptoms

Background: Although different gastric shapes are encountered in gastric emptying scintigraphy (GES), it is not known whether gastric shape is related to gastric emptying (GE) or symptoms. Aim: To investigate different stomach shapes observed during GES and examine their associations with GE, body weight, and gastrointestinal (GI) symptoms. Methods: This was a retrospective review of GES studies performed at our institution. Patients with prior gastric surgery were excluded. A classification of gastric shapes included: crescentic, J-shaped, reversed-L, cylindrical, and bag-like. Gastric shapes were correlated with GE, BMI, and GI symptoms using PAGI-SYM. Results: 397 GES studies were reviewed (317 females, age 40.0 ± 20.3 years, BMI 27.8 ± 13.8 kg/m²). Gastric shapes were: 41.8% crescentic/comma-shaped, 34.0% J-shaped, 19.9% reversed L-shape, 2.8% cylindrical, and 1.5% bag-like. BMI was highest in crescentic/comma-shaped stomachs (30.1 ± 12.4 kg/m²) and lowest in bag-like stomachs (25.2 ± 9.9 kg/m²; p = 0.022). Delayed GE was most pronounced in bag-like stomachs (34.4 ± 33.1% retention at 4 h) and lowest in reversed-L shape (10.3 ± 15.6% retention at 4 h; p = 0.008). Regurgitation severity was greatest in bag-like stomachs (2.2 ± 1.5) compared to milder symptoms in reversed-L shape (1.3 ± 1.4; p = 0.029). Heartburn severity was increased in bag-like stomachs (2.3 ± 1.6) while patients with cylindrical stomachs reported least heartburn severity (1.1 ± 1.3; p = 0.11). Conclusions: A classification system based on five gastric shapes observed during GES showed that crescent-shaped stomach was the most common shape and correlated with higher BMIs. Delayed GE was most pronounced in bag-like stomachs and lowest in reversed-L stomachs. Regurgitation and heartburn severity were greatest in bag-like stomachs with milder symptoms in reversed-L stomachs. Thus, gastric shape during GES is associated with gastric emptying, BMI, and symptom severity.