Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding

Arch Surg. 2000 Sep;135(9):1076-81; discussion 1081-2. doi: 10.1001/archsurg.135.9.1076.


Hypothesis: Cinematic technetium Tc 99m red blood cell ((99m)Tc-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 (99m)Tc-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 (99m)Tc-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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Diverticulum, Colon / complications
  • Female
  • Gastrointestinal Hemorrhage / diagnostic imaging*
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Male
  • Middle Aged
  • Radionuclide Imaging
  • Retrospective Studies
  • Sensitivity and Specificity
  • Technetium Compounds


  • Technetium Compounds