Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding

Hypothesis: Cinematic technetium Tc 99m red blood cell (Tc-99m-RBC) scans, in which real-time scanning is performed and analyzed, can accurately local ize gastrointestinal bleeding and thus direct selective surgical interventi on. Design: Retrospective medical record review with historical controls. Setting: Large, university-affiliated public hospital in urban setting. Patients: Twenty-six patients presenting with upper and lower gastrointesti nal hemorrhage who underwent cinematic Tc-99m-RBC scan examinations between 1990 and 1997 and required surgical intervention to control the bleeding. Interventions: All patients with gastrointestinal bleeding underwent open s urgical procedures to provide cessation of bleeding and resection of approp riate abnormalities. Main Outcome Measures: Patient outcome was based on correlation between pre operative RBC scans and intraoperative findings, surgical pathology, and po stoperative clinical course. Results: Twenty-five (96%) of 26 scans were interpreted as positive for gas trointestinal bleeding. In 22 of these 25 scans, the site of bleeding was c orrectly identified for a sensitivity of 88%. One or more additional diagno stic tests were performed on 19 (73%) of 26 patients, and included angiogra phy and flexible endoscopy. The most common operation performed to control bleeding was a hemicolectomy (14/26). Diverticulosis was the most prevalent diagnosis (46%). Two patients (8%) experienced rebleeding after operation. The overall mortality rate was 19% (5/26). Conclusions: Cinematic Tc-99m-RBC scintigraphy is a sensitive, noninvasive alternative to mesenteric angiography for accurately localizing the site of gastrointestinal hemorrhages. As such, this technique call be reliably use d to direct selective surgical intervention.