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Diagnosis of Bleeding Meckel's Diverticulum in Adults
Sung Noh Hong1, Hyun Joo Jang2, Byong Duk Ye3
1Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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.
Insights
Balloon-assisted enteroscopy (BAE) is the most accurate diagnostic tool for bleeding Meckel's diverticulum (MD) in adults. This study found BAE significantly outperformed other methods, including Meckel's scan, for preoperative diagnosis.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Diagnostics
Background:
- Diagnosing Meckel's diverticulum (MD) presents challenges due to unsatisfactory accuracy of current modalities.
- Limited data exists on diagnosing bleeding MD specifically in adults, a relatively rare condition.
Purpose of the Study:
- To determine the most accurate diagnostic modality for preoperative identification of bleeding Meckel's diverticulum in adult patients.
- To compare the diagnostic accuracy of various imaging and endoscopic techniques for bleeding MD.
Main Methods:
- Retrospective analysis of diagnostic accuracy for small bowel bleeding associated with MD in adult patients (≥18 years).
- Evaluation of modalities including Meckel's scan, capsule endoscopy, balloon-assisted enteroscopy (BAE), angiography, computed tomography, and small-bowel follow-through.
- Comparison against technetium-99m pertechnetate scintigraphy (Meckel's scan) as the gold standard for pediatric bleeding MD.
Main Results:
- Thirty-five adult cases of bleeding MD were identified between 2005-2012, with 68.6% diagnosed preoperatively.
- Balloon-assisted enteroscopy (BAE) demonstrated the highest diagnostic accuracy at 85.0% (95% CI: 61.1%-96.0%).
- BAE's accuracy was significantly higher than Meckel's scan (21.4%, P = 0.001), capsule endoscopy (35.7%), and computed tomography (31.8%).
Conclusions:
- Balloon-assisted enteroscopy (BAE) is the most accurate modality for diagnosing bleeding Meckel's diverticulum in adults.
- BAE should be considered the preferred method for preoperative diagnosis of bleeding MD in the adult population.
- Further research may refine the role of other modalities in specific clinical scenarios.
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