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  • Title: Retrospective study of the utility of nuclear scintigraphic-labelled red cell scanning for lower gastrointestinal bleeding.
    Author: Levy R, Barto W, Gani J.
    Journal: ANZ J Surg; 2003 Apr; 73(4):205-9. PubMed ID: 12662227.
    Abstract:
    BACKGROUND: The aim of the present study was to evaluate the utility of nuclear scintigraphic-labelled red cell scanning in the management of bleeding in patients with acute lower gastrointestinal haemorrhage (GIH) who require surgery. METHODS: A prospective database was used to source data on all patients with lower GIH who underwent technetium-99m (99mTc)-labelled red cell scanning over a 10-year period. A subgroup was identified from cross-reference with the medical records identifying only those patients who continued to bleed and subsequently required laparotomy for further detailed retrospective study. One key question was asked: did the labelled red cell scan influence the type of operation performed by the operating surgeon? RESULTS: The study identified 249 patients who underwent 287 labelled red cell scans for GIH. Forty patients (16%) underwent laparotomy for ongoing bleeding; 28/40 (70%) of the red cell scans were positive for bleeding. Six patients (15%) died postoperatively, none because of continued bleeding. The 99mTc-labelled red cell scan was deemed to have been unhelpful in 22 (55%) cases. Twelve of the 22 scans were negative and 10 of the 22 scans were positive but were ignored by the surgeon. The 99mTc-labelled red cell scan influenced the choice of operation in 18 out of 40 patients (45% of the operated group but only 7.2% of the total scanned group). Of these, 15 patients underwent colonic resection and three patients underwent small bowel resection. CONCLUSION: The present study demonstrates that labelled red cell scanning has only a small role to play in managing lower GIH. The 99mTc-labelled red cell scanning should be used much more selectively. Its use should be limited to patients who continue to bleed after conservative management; it may allow these patients to be effectively treated by segmental bowel resection. Its most critical role, however, is probably to prevent suspected small bowel bleeding from being missed at operation.
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