THE USE OF TECHNETIUM-LABELED ERYTHROCYTE SCINTIGRAPHY IN THE EVALUATION AND TREATMENT OF LOWER GASTROINTESTINAL HEMORRHAGE

The percentage of incorrect operations performed as a result of techne tium-labeled erythrocyte scintigraphy has been reported as high as 42 per cent. Recent studies have found scintigraphy to be superior to ang iography and propose that it be used as the primary diagnostic test in patients with lower gastrointestinal (GI) bleeding. A retrospective a nalysis was conducted of 105 patients with the symptoms of lower GI he morrhage to determine the effect of erythrocyte scintigraphy on surgic al management. Operative and pathology results were analyzed to determ ine the accuracy of the scintigraphy for localization of the bleeding source. In addition to tagged erythrocyte scans, 95 of 105 patients ha d additional diagnostic procedures: colonoscopy (78), upper endoscopy (47), and angiography (9). Scintigraphy localized a site of bleeding i n 42 patients (colon, 29; jejunum/ileum, 10; duodenum, 2; esophagus, 1 ). Surgical intervention was required in 25 patients, and the site of bleeding was correctly determined by scintigraphy in 22 of these patie nts (88%). The scans were negative in two patients, and the bleeding s ite was incorrectly reported in another. The patients who had operatio ns were significantly more likely to have positive scintigraphy than t he nonoperative group (P < 0.05). Preoperative localization of GI hemo rrhage is possible in most patients with technetium-labeled erythrocyt e scans (88% of operative patients). When combined with other tests to exclude upper GI bleeding, scintigraphy is a reliable means of guidin g surgical intervention.