Technetium-labeled erythrocyte scintigraphy in acute gastrointestinal bleeding
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ORIGINAL ARTICLE
Technetium-labeled erythrocyte scintigraphy in acute gastrointestinal bleeding James H. Tabibian & Louis M. Wong Kee Song & Felicity B. Enders & Jaime C. Aguet & Neshan Tabibian
Accepted: 2 February 2013 / Published online: 14 February 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Optimal management of acute gastrointestinal (GI) bleeding requires accurate localization of the bleeding source. The role of technetium-labeled erythrocyte scintigraphy (tagged red blood cell (TRBC) scan) in evaluating acute GI bleeding has been controversial, though recent literature suggests that it is a reliable tool and may be used as a first-line diagnostic test. We evaluated our recent experience with and the clinical outcomes of the TRBC scan in patients presenting with acute GI bleeding. Methods A retrospective study of 100 consecutive TRBC scans performed between April 2006 and January 2009 was conducted. Medical records of each corresponding patient were queried for pertinent data. Twenty TRBC scans performed for occult GI bleeding or >48 h after hospital admission were excluded. Results Of the 80 TRBC scans, 29 (36 %) were positive and 51 (64 %) were negative for bleeding. Eight (10 %) were incorrect positive (leading to five incorrect operations), 12 (15 %) true positive, 9 (11 %) unconfirmed positive, 17 (21 %) false negative, and 34 (43 %) unconfirmed negative. J. H. Tabibian (*) : L. M. Wong Kee Song Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA e-mail: [email protected] F. B. Enders Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN, USA J. C. Aguet Department of Nuclear Medicine, Kaweah Delta Hospital, Visalia, CA, USA N. Tabibian Division of Gastroenterology and Hepatology, Kaweah Delta Hospital, Visalia, CA, USA
The cause of bleeding was confirmed in 31 cases, of which the scan result was incorrect positive in 2 (7 %), true positive in 12 (39 %), and false negative in 17 (55 %). Conclusions TRBC scans have low positive yield as well as high incorrect positive and high false negative rates in patients with acute GI bleeding. Further research is needed to improve scan technique, refine patient selection, and determine in what setting TRBC scanning may be more clinically useful. Keywords Radionuclide imaging . Gastrointestinal bleeding . Diverticular disease
Introduction Acute gastrointestinal (GI) bleeding is a common, potentially life-threatening condition with mortality rates as high as 10– 14 % [1, 2]. Although acute GI bleeding ceases spontaneously in the majority of cases [1, 3], depending on the etiology, a considerable proportion of patients will require accurate diagnosis and localization of the bleeding source for appropriate management [4]. In some cases, this may in fact be more challenging than the actual treatment [3, 5, 6]. Several modalities exist to localize GI bleeding, including noninvasive imaging, angiography, endoscopy, and surgery; the choice of modality is dependent upon local resource
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