Double-balloon enteroscopy for the diagnosis of Meckel's diverticulum in pediatric patients with obscure GI bleeding

Abstract

found. 1 One study documented 600 cases of Meckel’s diverticulum, with only 6% of those cases being diagnosed correctly. 2 An accurate preoperative diagnosis of bleeding Meckel’s diverticulum in children is a continuing challenge for pediatricians because its clinical and imaging features simulate those of other acute abdominal conditions. The technetium-99mpertechnetatescan(Meckel’sscan),dependent on the uptake of the pertechnetate anion by ectopic gastric mucosa, is the most well-established method for detecting Meckel’s diverticulum, with a sensitivity and specificity of 85% and 95%, respectively. 3 As reported, the specificity of a Meckel’s scan in our unit is 97.7%. 4 Although the sensitivity and specificity are high, falsepositiveandfalse-negativescansarefrequentlyencountered. In these cases, radiography and ultrasonogram of the abdomen are not able to provide a definitive diagnosis. Intraoperative enteroscopy is the most complete but also most invasive procedure for examination of the small bowel and may be unacceptable by the parents. In addition, diagnostic laparoscopy or laparotomy could be used, but there still exists the possibility of missing some short diverticula. Under such circumstances, endoscopy may be helpful. It was reported that the mean distance from the diverticulum to the ileocecal valve was 34 cm in children aged !2 years, 46 cm in patients aged 3 to 21 years, and 67 cm in adults aged 21 years or more. 2 The diverticulum is out of reach of conventional upper endoscopy or ileocolonoscopy, and frequent blood transfusions are required for the bleeding. Double-balloon enteroscopy (DBE) is a new method that allows complete visualization, biopsy, and treatment in the small bowel. Obscure GI bleeding is the most common indication for DBE. The pooled detection rate was 68.1%. 5 The use of DBE in the detection of Meckel’s diverticulum was first described by Gasbarrini et al. 6 To the best of our knowledge, about 10 cases of Meckel’s diverticulum diagnosed by DBE and treated by laparoscopic surgery have been reported in the English literature. However, uncertainty remains about the diagnostic value and safety of DBE in pediatric patients. We report here 28 cases of children with obscure GI bleeding with false-negative Meckel’s scans. Ten of them were diagnosed as having Meckel’s diverticulum by DBE.