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Background
Gastroparesis is a functional disorder of stomach motility commonly caused by vagus nerve injury. The diagnostic gold standard for gastroparesis is Gastric Emptying Scintigraphy (GES) using a 99mTc sulfur colloid radiolabeled solid meal. Normal gastric emptying includes: =70% meal retention at 0.5 hours, 30-90% at 1 hour, =60% at two hours, and =10% at 4 hours. Abnormal gastric emptying at 4 hours is graded in severity using the following system: Grade 1 (mild) – 11-20% retention, Grade 2 (moderate) – 21-35% retention, Grade 3 (severe) – 36-50% retention, Grade 4 (very severe) – >50% retention. Treatments include lifestyle changes, medical management, Botox therapy, pyloric stimulation, and surgery. In this educational exhibit, we will discuss emerging research and quality improvement efforts directed towards advancing the diagnostic capabilities of GES in patients who may not tolerate standardized meals, pediatric patient population techniques, and the utility of GES in monitoring treatment response and efficacy in various current and emerging treatments for gastroparesis and functional dyspepsia.

Educational Goals / Teaching Points
Radiologic approach to technique, imaging, and reporting of gastric emptying scintigraphy (GES) with special focus on emerging research and quality improvement projects that explain the diagnostic role of GES as it relates to gastroparesis, and explains technique, imaging, and reporting of solid and liquid GES including a special section on pediatric technique, to include overview of technique including radiotracer, standardized meals, and other considerations, systematic interpretation of solid versus liquid GES studies, with example cases, and standardization of terminology and reporting of solid and liquid GES studies. Highlight emerging research and quality improvement projects in the field include initiatives for liquid and solid GES studies for all populations, emerging research on intragastric meal distribution, and benefits of endoscopic Botox as an adjunct for refractory cases.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Gastroparesis, functional dyspepsia, treatment response, botulinum toxin treatment, standardized liquid meals, 99mTc-sulfur colloid , gastric emptying scintigraphy, and staging delayed gastric emptying.

Conclusion
We discussed emerging research and quality improvement efforts directed towards advancing the diagnostic capabilities of GES in patients who may not tolerate standardized meals, pediatric patient population techniques, the utility of GES in monitoring treatment response, and efficacy in various current and emerging treatments for gastroparesis and functional dyspepsia. We also highlighted our institutional experience as it pertains to patient cases which benefited from emerging GES capabilities. We believe that such approaches may improve patient care and experience, provide pertinent data related to treatment response, and provide alternative or adjunctive options to surgical management. GES is a powerful diagnostic study with emerging applications and new techniques that will enhance diagnostic and treatment capabilities, as well as patient experience.