Diagnosis of Bleeding Meckel's Diverticulum in Adults.
OBJECTIVE
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.
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sung Noh
SN
Hong
Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
Hyun Joo
HJ
Jang
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Byong Duk
BD
Ye
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Seong Ran
SR
Jeon
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jong Pil
JP
Im
Gang Dong Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Jae Myung
JM
Cha
Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Seong-Eun
SE
Kim
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Soo Jung
SJ
Park
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eun Ran
ER
Kim
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Dong Kyung
DK
Chang
D000328:Adult; D000071087:Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000178:diet therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies