Significance of scintigraphy for the localisation of obscure gastrointestinal bleedings

作     者：Tanja Brünnler Frank Klebl Sascha Mundorff Christoph Eilles Michael Reng Hans von Korn Jürgen Schlmerich Julia Langgartner Stefan Grüne 

作者机构：Department of Internal Medicine I University of Regensburg Department of Surgery Hospital Neumarkt Department of Nuclear Medicine University of Regensburg Department of Internal Medicine Hospital Bogen Department of Internal Medicine II Hospital Hetzelstift 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2008年第14卷第32期

页      面：5015-5019页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Gastrointestinal bleeding Scintigraphy Localisation Angiography 

摘      要：AIM： To determine the role of scintigraphy in patients with gastrointestinal （GI） bleeding of unknown Iocalisation. METHODS： We performed retrospective analyses on 92 patients receiving scintigraphies from 1993 to 2000 in the University of Regensburg hospital, which were done for Iocalisation of GI bleeding as a diagnostic step after an unsuccessful endoscopy. In addition to the scintigraphies, further diagnostic steps such as endoscopy, angiography or operations were performed. In some of the scintigraphies with negative results, a provocation test for bleeding with heparinisation was carried out. RESULTS： 73% of all scintigraphies showed a positive result. In 4.5% of the positive results, the source was located in the stomach, in 37% the source was the small bowel, in 25% the source was the right colon, in 4.5% the source was the left colon, and in 20% no clear Iocalisation was possible. Only 4% of all scintigraphies were false positive. A reliable positive scintigraphy was independent of the age of the examined patient. A provocation test for bleeding with heparin resulted in an additional 46% of positive scintigraphies with a reliable Iocalisation in primary negative scintigraphies. CONCLUSION- Our results show that scintigraphy and scintigraphy with heparin provocation tests are reliable procedures. They enable a reliable Iocalisation in about half of the obscure GI-bleeding cases. Scintigraphy is superior to angiography in locating a bleeding. It is shown that even in the age of video capsule endoscopy and double-balloon enteroscopy, scintigraphy provides a reliable and directed localization of GI bleeding and offers carefully targeted guidance for other procedures.