Diagnostic Accuracy of Meckel Scan with Initial Hemoglobin Level to Detect Symptomatic Meckel Diverticulum.

Abstract

Meckel scan is an effective tool for diagnosing symptomatic Meckel diverticulum (MD). However, the clinical relevance of Meckel scan remains controversial because of its rare use. To evaluate the clinical relevance of Meckel scan with initial hemoglobin (Hb) level, we investigated its diagnostic accuracy in our patient population over a 10-year period, and we propose clinical considerations for Meckel scan with initial Hb levels. A total of 70 patients (41 males and 29 females; median age, 3 years; range, 3 months to 49 years) who underwent Meckel scans for symptomatic MD evaluation from October 2003 to August 2012 were reviewed retrospectively. Of the 70 patients, 13 were pathologically confirmed by surgery. Nine patients had MD, and the others were diagnosed with gastritis, colitis, and juvenile polyps. Overall, 57 patients were evaluated with endoscopy and clinical examinations, and were followed up for 3 to 6 years. The patients were classified into two groups by their initial Hb levels. Group I consisted of anemic patients whose initial Hb levels were less than the reference range for each individual's age and sex (n = 16), and group II consisted of patients within the normal range for Hb level (n = 52). The two groups were compared using Fisher exact test. Of the 70 patients, 9 (12.3%) showed positive findings on Meckel scan, and the others demonstrated negative findings. In the negative scan group, 1 patient was confirmed as MD after surgery; 60 patients showed spontaneous improvement and no symptom recurrence was detected during the 3- to 6-year follow-up. In the positive Meckel scan group, eight patients were pathologically diagnosed with MD. One patient was reported as having a juvenile polyp with no evidence of ectopic gastric mucosa. The sensitivity and specificity of Meckel scan were 89 and 98%, respectively. In group I, Meckel scan was positive in seven patients (44%) and showed a significantly higher prevalence than in group II (p < 0.001). When limited to the patients with gastrointestinal bleeding and anemia, the positive predictive value and negative predictive value were 100 and 100%, respectively. In this study, Meckel scan showed high diagnostic accuracy in detecting symptomatic MD. Meckel scan also showed the highest positive results when applied in patients with gastrointestinal bleeding who were in anemic conditions.