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World J Gastroenterol. Aug 28, 2008; 14(32): 5015-5019
Published online Aug 28, 2008. doi: 10.3748/wjg.14.5015
Significance of scintigraphy for the localization of obscure gastrointestinal bleedings
Tanja Brünnler, Frank Klebl, Sascha Mundorff, Christoph Eilles, Michael Reng, Hans von Korn, Jürgen Schölmerich, Julia Langgartner, Stefan Grüne
Tanja Brünnler, Frank Klebl, Jürgen Schölmerich, Julia Langgartner, Department of Internal Medicine I, University of Regensburg, Regensburg D-93042, Germany
Hans von Korn, Stefan Grüne, Department of Internal Medicine II, Hospital Hetzelstift, Neustadt D-67434, Germany
Sascha Mundorff, Department of Surgery, Hospital Neumarkt, Neumarkt D-92318, Germany
Christoph Eilles, Department of Nuclear Medicine, University of Regensburg, Regensburg D-93042, Germany
Michael Reng, Department of Internal Medicine Hospital Bogen, Bogen 94327, Germany
Author contributions: Klebl F, Mundorff S, Eilles C, Reng M, von Korn H, Schölmerich J, and Grüne S designed the study; Klebl F, Mundorff S, Eilles C, Reng M, von Korn H, Schölmerich J, Langgartner J, and Grüne S performed the study; Brünnler T, Mundorff S, Schölmerich J, Langgartner J, and Grüne S analyzed the data; Brünnler T and Langgartner J wrote the paper.
Correspondence to: Tanja Brünnler, MD, Klinik und Poliklinik fuer Innere Medizin I, Klinikum der Universität Regensburg, Regensburg D-93042, Germany. tanja.bruennler@klinik.uni-r.de
Telephone: +49-941-9447010 Fax: +49-941-9447107
Received: April 5, 2008
Revised: July 13, 2008
Accepted: July 20, 2008
Published online: August 28, 2008
Abstract

AIM: To determine the role of scintigraphy in patients with gastrointestinal (GI) bleeding of unknown localization.

METHODS: We performed retrospective analyses on 92 patients receiving scintigraphies from 1993 to 2000 in the University of Regensburg hospital, which were done for localization of GI bleeding as a diagnostic step after an unsuccessful endoscopy. In addition to the scintigraphies, further diagnostic steps such as endoscopy, angiography or operations were performed. In some of the scintigraphies with negative results, a provocation test for bleeding with heparinisation was carried out.

RESULTS: 73% of all scintigraphies showed a positive result. In 4.5% of the positive results, the source was located in the stomach, in 37% the source was the small bowel, in 25% the source was the right colon, in 4.5% the source was the left colon, and in 20% no clear localization was possible. Only 4% of all scintigraphies were false positive. A reliable positive scintigraphy was independent of the age of the examined patient. A provocation test for bleeding with heparin resulted in an additional 46% of positive scintigraphies with a reliable localization in primary negative scintigraphies.

CONCLUSION: Our results show that scintigraphy and scintigraphy with heparin provocation tests are reliable procedures. They enable a reliable localization in about half of the obscure GI-bleeding cases. Scintigraphy is superior to angiography in locating a bleeding. It is shown that even in the age of video capsule endoscopy and double-balloon enteroscopy, scintigraphy provides a reliable and directed localization of GI bleeding and offers carefully targeted guidance for other procedures.

Keywords: Gastrointestinal bleeding; Scintigraphy; Localization; Angiography