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Brian B. O'Neill, MD; Jessica E. Gosnell, MD; Robert J. Lull, MD; William P. Schecter, MD; Johannes Koch, MD; Robert A. Halvorsen, MD; Hobart W. Harris, MD, MPH

Arch Surg. 2000;135:1076-1081.

Hypothesis  Cinematic technetium Tc 99m red blood cell (^99mTc-RBC) scans, in which real-time scanning is performed and analyzed, can accurately localize gastrointestinal bleeding and thus direct selective surgical intervention.

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 gastrointestinal hemorrhage who underwent cinematic ^99mTc-RBC scan examinations between 1990 and 1997 and required surgical intervention to control the bleeding.

Interventions  All patients with gastrointestinal bleeding underwent open surgical procedures to provide cessation of bleeding and resection of appropriate abnormalities.

Main Outcome Measures  Patient outcome was based on correlation between preoperative RBC scans and intraoperative findings, surgical pathology, and postoperative clinical course.

Results  Twenty-five (96%) of 26 scans were interpreted as positive for gastrointestinal bleeding. In 22 of these 25 scans, the site of bleeding was correctly identified for a sensitivity of 88%. One or more additional diagnostic tests were performed on 19 (73%) of 26 patients, and included angiography 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 ^99mTc-RBC scintigraphy is a sensitive, noninvasive alternative to mesenteric angiography for accurately localizing the site of gastrointestinal hemorrhages. As such, this technique can be reliably used to direct selective surgical intervention.

From the Departments of Surgery (Drs O'Neill, Gosnell, Schecter, and Harris), Radiology (Drs Lull and Halvorsen), and Medicine (Dr Koch), San Francisco General Hospital, University of California, San Francisco.

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