[Clinical value of scintigraphy for gastrointestinal bleeding. Experiences in a large community hospital].

BACKGROUND AND OBJECTIVE

In the majority of cases of gastrointestinal bleeding the site and cause can be determined by gastroscope. If this is unsuccessful, radiological and nuclear-medical tests are available. This study was undertaken to determine the value of scintigraphy in diagnosing of the site of gastrointestinal bleeding.

PATIENTS AND METHODS

The data on 155 patients who, between 1984 and 1988, had undergone 161 scintigraphies (with 99mTc-labelled erythrocytes, 5 with 99mTc-Sn colloid) were retrospectively analysed. The results were compared with other diagnostic tests that had been performed, with the definitive diagnosis and, where applicable, the findings at surgery.

RESULTS

78 scintigrams (47%) provided positive results. The site of bleeding had been demonstrated ca. 20 hours after the diagnostic studies had begun. In 47 of the cases the diagnosis was confirmed by additional tests. The intestine was the most common site of bleeding. Localization of the source of bleeding by scintigraphy and other diagnostic tests succeeded in 34 cases, with a 82% concordance between the tests. No bleeding was demonstrated in 88 scintigrams (53%), including all those done with Sn-colloid. In 13 cases the final diagnosis suggested that there had been no previous bleeding and in 43 cases the source of bleeding could not be determined. In 32 scintigraphically negative cases the source of bleeding was demonstrated by other tests. But only 2 of the 13 angiograms and none of the 33 double-contrast studies of the small intestine gave positive results. Among the total number of cases in which bleeding was demonstrated, scintigraphy had a sensitivity of 71%.

CONCLUSION

Because of the long duration of observation, scintigraphy with 99mTc-labelled erythrocytes proved superior to other diagnostic tests in the demonstration of the bleeding. By localizing the source of bleeding in a definite part of the gastrointestinal tract, scintigraphy points the way to choosing other diagnostic methods or treatment. If the initial endoscopy has failed, scintigraphy, a method of low invasiveness, should be included when further tests are planned.