[Nuclear medicine applications of the gastrointestinal tract in pediatric surgery]

There are pathological entities of the gastrointestinal tract whose investigation and follow-up remain quite challenging for pediatric surgeons. Although there are many new diagnostic techniques, radionuclide applications still remain important. Nuclear medicine plays a crucial role in diagnosis of biliary atresia and contributes to its differential diagnosis from neonatal hepatitis with an accuracy of 95% through cholescintigraphy. This method also detects postoperative complications, such as bile leaks and obstruction after liver transplantation in children. Technetium-99m pertechnetate scan is considered the standard method for preoperative diagnosis of a Meckel's diverticulum, characterized by a specificity of 95% and a sensitivity of 85%. Milk scan is the most sensitive noninvasive method for detecting gastroesophageal reflux, due to its high temporal acquisition rate and reveals tracheoesophageal communications in neonates suffering from persistent cough and recurrent pulmonary infections. Finally, in case of necrotizing enterocolitis, Nuclear Medicine has to offer the measurement by radioimmunological methods of markers such as IL-6, T- antigen, I-FABP, glutathione S-transferase and β-galactocidase of intestinal mucosa cells, which are useful in the diagnosis, follow-up and prognosis of the disease. In conclusion, radionuclide techniques in the investigation of the gastrointestinal tract in neonates and children are useful functional methods, with lower radiation exposure compared to radiological techniques that are usually applied.