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Diagnosis of Bleeding Meckel's Diverticulum in Adults

 Sung Noh Hong  ;  Hyun Joo Jang  ;  Byong Duk Ye  ;  Seong Ran Jeon  ;  Jong Pil Im  ;  Jae Myung Cha  ;  Seong-Eun Kim  ;  Soo Jung Park  ;  Eun Ran Kim  ;  Dong Kyung Chang 
 PLOS ONE, Vol.11(9) : e0162615, 2016-09 
Journal Title
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Adult ; Balloon Enteroscopy ; Female ; Gastrointestinal Hemorrhage / diagnosis* ; Gastrointestinal Hemorrhage / diet therapy ; Gastrointestinal Hemorrhage / etiology ; Humans ; Male ; Meckel Diverticulum / complications ; Meckel Diverticulum / diagnosis* ; Meckel Diverticulum / diagnostic imaging ; Positron Emission Tomography Computed Tomography ; Retrospective Studies
Background and aims: Various modalities have been used to diagnose Meckel's diverticulum (MD) in practice, but with their diagnostic accuracy deemed to be unsatisfactory for clinical practice. Moreover, the usefulness of these modalities has not been evaluated for the diagnosis of bleeding MD in adults, due to the relative rarity of this condition. Therefore, the aim of our multicenter study was to determine the most accurate modality for the preoperative diagnosis of bleeding MD in adults. Methods: We conducted a retrospective analysis of the diagnostic accuracy for small bowel bleeding associated with MD of different modalities in patients ≥18 years old who underwent assessment for MD, with confirmation at the time of explorative surgery. Diagnostic accuracy of the different modalities was evaluated against the diagnosis obtained using technetium-99m pertechnetate scintigraphy (also known as Meckel's scan), considered to be the gold standard for the diagnosis of bleeding MD in pediatrics. Results: Thirty-five adults were identified with bleeding in MD over the study period, between 2005 and 2012. Among these patients, only 24 (68.6%) were diagnosed with MD preoperatively. The mean (95% confidence interval) diagnostic accuracy of selected modalities was as follows: Meckel's scan, 21.4% (5.7%-51.2%); capsule endoscopy, 35.7% (14.0%-64.4%); balloon-assisted enteroscopy (BAE), 85.0% (61.1%-96.0%); angiography, 0.0% (0.0%-80.2%); computed tomography, 31.8% (14.7%-54.9%); and small-bowel follow-through, 62.5% (25.9%-90.0%). The diagnostic accuracy was significantly higher for BAE than for Meckel's scan (P = 0.001). Conclusions: Among available diagnostic modalities, BAE provides the highest accuracy for the diagnosis of bleeding MD in adults and, therefore, should be considered as the preferred modality for preoperative diagnosis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Soo Jung(박수정)
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