Single-Photon Emission Computed Tomography Enhanced Tc-99m-Pertechnetate Disodium-Labelled Red Blood Cell Scintigraphy in the Localization of Small Intestine Bleeding: A Single-Centre Twelve-Year Study

Doležal, J; Vízda, J; Kopáčová, Marcela

doi:10.1159/000328389

Cited by 30 publications

(16 citation statements)

References 18 publications

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“…Th ere is a wide range of reported sensitivities (33-93%), specifi city (30-95%), diagnostic yields (26-87%), and localization accuracy (19-100%) for scintigraphy throughout the GI tract ( 164,(171)(172)(173)(174)(175)(176)(177)(178)(179)(180). Because bleeding is intermittent, scintigraphy may be helpful in identifying the site of bleeding when other diagnostic tests have been negative (180)(181)(182).…”

Section: Scintigraphy 99mmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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Section: Scintigraphy 99mmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

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“…Patients with slower rates of bleeding can be better evaluated with scintigraphy, particularly if a patient presents later after the onset of bleeding [8]. The overall diagnostic yield varies among reports in the literature (45-73%) [57][58][59][60][61]. One prospective study assessed the use of scintigraphy in the evaluation of obscure overt bleeding and found an overall yield of 65% with a localization accuracy of 75% [61].…”

Section: Radiologic Evaluationmentioning

confidence: 99%

Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease

Muftah¹

2019

aog

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Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.

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“…Patients with positive RBC scan results should be referred immediately to angiography for treatment. Results from studies of technetium-labeled RBC scintigraphy vary widely [109][110][111][112] and may reflect differences in patient selection and timing of the study in relation to clinical presentation of bleeding. In 1 study of 103 patients with suspected small-bowel bleeding, scintigraphy failed to localize hemorrhage in 85% of cases.…”

Section: Role Of Intraoperative Enteroscopymentioning

confidence: 99%