Share This Article:

Rethinking an Algorithm: The Utility of the Techinicium 99 m Labeled Red Cell (RBC) Scanning for Lower Gastrointestinal Bleeding (LGIB)

Abstract Full-Text HTML Download Download as PDF (Size:77KB) PP. 110-114
DOI: 10.4236/ijcm.2012.32023    4,342 Downloads   6,382 Views  

ABSTRACT

Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy. Methods: Records of patients admitted to Cooper University Hospital from January 2001-December 2005 with LGIB who had 99mTc scan were analyzed. Results: 164 of 170 patients were eligible to be evaluated. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of 45 patients with positive scans had angiography. 7 patients (33.3%) had positive and 14 (66.6%) negative angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99 m Tc scan (p = 0.125). 20 patients, in the positive scan group, required surgery. In 15 (75%) the findings at surgery correlated with the scan result (p = 0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p < 0.001). The patients with (+) scan received a total of 372 (8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (–) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (–) scans had similar rates of colonoscopy (73.35% vs 76.4%), hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%) respectively, Conclusion: 99 m Tc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. R. S. Mok, C. Ojiako, A. Kalra, M. Gajera and S. Sujanthy Rajaram, "Rethinking an Algorithm: The Utility of the Techinicium 99 m Labeled Red Cell (RBC) Scanning for Lower Gastrointestinal Bleeding (LGIB)," International Journal of Clinical Medicine, Vol. 3 No. 2, 2012, pp. 110-114. doi: 10.4236/ijcm.2012.32023.

References

[1] J. J. Farrell and L. S. Friedman, “Gastrointestinal Bleeding in the Elderly,” Gastroenterology Clinics of North America, Vol. 30, No. 2, 2001, pp. 377-407. doi:10.1016/S0889-8553(05)70187-4
[2] A. S. Fauci, E. Braunwald, D. L. Kasper, et al., “Harrison’s Principles of Internal Meidcine,” 17th Edition, McGraw-Hill Companies, Inc., New York, 2008.
[3] T. E. Garofalo and R. A. Abdu, “Accuracy and Efficacy of Nuclear Scintigraphy for the Detection of Gastroin-testinal Bleeding,” Archives of Surgery, Vol. 132, No. 2, 1997, pp. 196-199. doi:10.1001/archsurg.1997.01430260094020
[4] M. S. Suzman, M. Talmor, et al., “Accurate Localization and Surgical Management of Active Lower Gastroin-testinal Hemorrhage with Technetium-Labeled Erythrocyte Scintigraphy,” Annals of Surgery, Vol. 226, No. 1, 1997, pp. 112-113.
[5] R. Levy, W. Barto and J. Gani, “Retrospective Study of the Utility of Nuclear Scintigraphic-Labeled Red Cell Scanning for Lower Gastrointestinal Bleeding,” Annals of Surgery, Vol. 73, 2003, pp. 205-220. doi:10.1046/j.1445-1433.2002.02567.x
[6] D. A. Zukerman, T. P. Bocchini and E. H. Birnbaum, “Massive Hemorrhage in the Lower Gastrointestinal Tract in Adults: Diagnostic Imaging and Intervention,” American Journal of Roentgenology, Vol. 161, No. 4, 1993, pp. 703-711.
[7] J. M. Hunter and M. E. Pezim, “Limited Value of Technetium 99 m-Labeled Red Cell Scintigraphy in Localization of Lower Gastrointestinal Bleeding,” American Journal of Surgery, Vol. 159, No. 5, 1990, pp. 504-506. doi:10.1016/S0002-9610(05)81256-5
[8] G. R. Voeller, G. Bunch and L. G. Britt, “Use of Technetium-Labeled Red Blood Cell Scintigraphy in the Detection and Management of Gastrointestinal Hemorrhage,” Surgery, Vol. 110, No. 4, 1991, pp. 799-804.
[9] P. V. Ford, S. P. Bartold, D. M. Fink-Bennett, et al., “Procedure Guideline for Gastrointestinal Bleeding and Meckel’s Diverticulum Scintigraphy. Society of Nuclear Medicine,” Journal of Nuclear Medicine, Vol. 40, No. 7, 1999, pp. 1226-1232.
[10] A. T. Hirsch, Z. J. Kaskal, C. W. Hertzer, et al., “ACC/AHA 2005 Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee
[11] A. Alavi and E. J. Ring, “Localization of Gastrointestinal Bleeding: Superiority of 99 mTc Sulfur Colloid Compared with Angiography,” American Journal of Roentgenology, Vol. 137, No. 4, 1981, pp. 741-748.
[12] D. A. Thorne, F. L. Datz, K. Remley, et al., “Bleeding Rates Necessary for Detecting Acute Gastrointestinal Bleeding with Technetium-99m-Labeled Red Blood Cells in an Experimental Model,” Journal of Nuclear Medicine, Vol. 28, No. 4, 1987, pp. 514-520.
[13] L. Defreyne, M. Uder, P. Vanlangenhove, et al., “Angiography for Acute Lower Gastrointestinal Hemorrhage: Efficacy of Cut Film Compared with Digital Subtraction Techniques,” Journal of Vascular and Interventional Radiology, Vol. 14, No. 3, 2003, pp. 313-322. doi:10.1097/01.RVI.0000058414.01661.77
[14] K. H. Barth, “Radiological Intervention in Upper and Lower Gastrointestinal Bleeding,” Baillieres Clinical Gastroenterology, Vol. 9, No. 1, 1995, pp. 53-69. doi:10.1016/0950-3528(95)90070-5
[15] W. Browder, E. J. Cerise and M. S. Litwin, “Impact of Emergency Angiography in Massive Lower Gastroin-testinal Bleeding,” Annals of Surgery, Vol. 204, No. 5, 1986, pp. 530-536. doi:10.1097/00000658-198611000-00004
[16] A. M. Vernava III, B. A. Moore, W. E. Longo, et al., “Lower Gastrointestinal Bleeding,” Diseases of the Colon & Rectum, Vol. 40, No. 7, 1997, pp. 846-858. doi:10.1007/BF02055445
[17] P. Orecchia, M. Hensley, P. Mcdonald, et al., “Localization of Lower Gastrointestinal Hemorrhage,” Archives of Surgery, Vol. 120, No. 5, 1985, pp. 621-624.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.