sodium-pertechnetate-tc-99m and Esophageal-and-Gastric-Varices

Gastrointestinal bleeding is a common and occasionally life-threatening problem in infants and children. A careful history and physical examination as well as the application of new endoscopic and radiographic techniques will reveal the source of hemorrhage in most patients. The utility of recently introduced pharmacologic agents and endoscopic techniques in the treatment of peptic disease and variceal hemorrhage in children remains to be determined. A cooperative effort among pediatricians, radiologists, and surgeons should minimize the morbidity and mortality from gastrointestinal tract bleeding in this population.

Topics: Angiography; Antacids; Barium Sulfate; Child; Colonoscopy; Digestive System; Endoscopy; Enema; Esophageal and Gastric Varices; Gastric Lavage; Gastrointestinal Hemorrhage; Hemostatic Techniques; Histamine H2 Antagonists; Humans; Infant; Infant, Newborn; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sigmoidoscopy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding.. Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using (99m)Technetium pertechnetate. The shunt index was calculated from the ratio of (99m)Technetium pertechnetate in the heart and the liver. Data were analyzed using Student's t-test and receiver operating characteristics.. Cirrhotic patients showed a higher shunt index than normal subjects (63.80 +/- 25.21 vs 13.54 +/- 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 +/- 9.40 vs 49.35 +/- 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding.. In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

Topics: Adolescent; Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Portal System; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Risk Factors; Sodium Pertechnetate Tc 99m

Propranolol can reduce portal hypertension, therefore is recommended in prevention of variceal bleeding in patients with liver cirrhosis. However, in certain patients with cirrhosis portal hypotensive effect of propranolol cannot be obtained, and the reason of this finding is unknown. In 28 patients with cirrhosis the effect of seven days administration of propranolol on collateral blood flow from inferior mesenteric vein was examined by means of per-rectal portal scintigraphy. Portosystemic shunt index was significantly reduced by propranolol by 17.4 +/- 4.8%. This reduction was observed in cirrhotics classified to A and B, but not C Child-Pugh. These data suggest that propranolol increases vascular resistance in portosystemic circulation which depends on severity of liver failure. This mechanism opposes reduction of portal pressure.

Topics: Adult; Aged; Blood Pressure; Collateral Circulation; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Middle Aged; Portal System; Propranolol; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vascular Resistance

Per-rectal portal scintigraphy with Tc-99m pertechnetate is a method to evaluate portosystemic shunting (shunt index) in inferior mesenteric vein. In this study the shunt index was estimated in patients with chronic liver disease in relation to the severity of liver injury, portal hypertension and incidence of oesophageal varices. Shunt index was elevated in patients with non-cirrhotic liver disease as compared with healthy normals (34 +/- 6% vs 8 +/- 2%; p < 0.0005). Moreover, patients with cirrhosis had the shunt index of 65 +/- 4% which was higher than in other groups. There was no correlation of the shunt index to the Child-Pugh classification, hepatic venous pressure gradient and varices size in the cirrhotic patients. Conversely, the shunt index differentiated variceal bleeders from non-bleeders (80 +/- 4% vx 59 +/- 6%; p < 0.005). These data show that peripheral collateral circulation develop in response to mild elevation of portal pressure, but its hemodynamic efficacy to alleviate portal hypertension seems to be unremarkable. High shunt index might reflect elevated risk of bleeding from varices.

Topics: Adult; Aged; Chronic Disease; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Hypertension, Portal; Liver Diseases; Male; Mesenteric Veins; Middle Aged; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m

Per-rectal portal scintigraphy is a non-invasive method in which a radioisotope is used for imaging of the portal collaterals. Per-rectal portal scintigraphy with 99m-technetium pertechnetate (99mTcO4-) was performed in 42 subjects to evaluate the portal hemodynamics. Ten healthy controls, 13 cases of liver cirrhosis without esophageal varices, 15 cases of liver cirrhosis with esophageal varices, and 4 cases of portal systemic shunt were included in this study. Moreover, in 4 patients who underwent transabdominal esophageal transection, per-rectal portal scintigraphy was repeated one month postoperatively. Portosystemic shunt index was calculated by the following equation. Shunt Index (%) = (99mTcO4 Counts of Heart/99mTcO4 Counts of Liver and Heart) x 100. The results, expressed as shunt index (SI) were: 8.8 +/- 5.2 in controls, 21.2 +/- 8.0 in cirrhotic patients without esophageal varices, 31.0 +/- 18.5 in cirrhotic patients with esophageal varices, and 49.0 +/- 6.9 in patients with portosystemic shunt. After transabdominal esophageal transection, the shunt indices were decreased in all four cases. Morphological improvements of the esophageal varices were also observed. These results suggest that the shunt index measured by per-rectal portal scintigraphy may be useful for assessment of portal collaterals, especially for patients with esophageal varices.

Topics: Adult; Aged; Esophageal and Gastric Varices; Hemodynamics; Humans; Middle Aged; Portal System; Portasystemic Shunt, Surgical; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The dynamic intravenous hepato-scintigraphy with pertechnetate Tc-99m enables a quantitative evaluation of portal and arterial blood flow in the liver. A case is presented of thrombotic occlusion of the portal vein with rapidly growing oesophageal varices in which hepato-scintigraphy showed the absence of portal blood flow in the liver, being the decisive diagnostic method. Using the dynamic transrectal porto-scintigraphy an evaluation was done of the degree of collateral circulation development in the area of the inferior mesenteric vein, obtaining indirect information about localization and duration of portal vein occlusion.

Topics: Adult; Esophageal and Gastric Varices; Hepatic Veno-Occlusive Disease; Humans; Liver Circulation; Male; Portal Vein; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombosis

Portal circulation in patients with liver diseases was evaluated by 99mTc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in the without, and also in the cirrhotic patients with encephalopathy than in those without. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices.

Topics: Adult; Esophageal and Gastric Varices; Female; Humans; Liver Diseases; Male; Middle Aged; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Portal circulation in patients with chronic liver diseases was evaluated by [99mTc]pertechnetate per-rectal scintigraphy. Technetium-99m pertechnetate (10 mCi) was instilled into the upper rectum, and serial scintigrams were taken. Radioactivity curves for the liver and heart were then recorded sequentially. Through analysis of these curves, the per-rectal portal shunt index (Sl) was calculated for six healthy subjects and 228 patients, 59 with chronic hepatitis, seven with idiopathic portal hypertension, six with primary biliary cirrhosis, and 156 with cirrhosis. In the healthy subjects, the Sl was 1.9-5.2% (mean 4.1%). In hepatitis, the mean Sl was 7.1%, and in cirrhosis, 52.9%. The Sl was higher in cirrhotic patients with esophageal varices than in those without (p less than 0.001), and in cirrhotic patients with encephalopathy than in those without (p less than 0.01). For some patients with portal hypertension, portal collateral circulation could be depicted, and images of changes in the portal collateral circulation after vascular anastomosis were seen.

Topics: Administration, Rectal; Adult; Chronic Disease; Collateral Circulation; Esophageal and Gastric Varices; Female; Heart; Hepatitis; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Cirrhosis, Biliary; Liver Diseases; Methods; Middle Aged; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vena Cava, Inferior

Topics: Aged; Esophageal and Gastric Varices; Evaluation Studies as Topic; Female; Hemodynamics; Humans; Male; Middle Aged; Portal System; Radionuclide Angiography; Sclerosing Solutions; Sodium Pertechnetate Tc 99m

Topics: Esophageal and Gastric Varices; Humans; Injections; Portal System; Radionuclide Imaging; Sclerosing Solutions; Sodium Pertechnetate Tc 99m

Topics: Esophageal and Gastric Varices; Hemodynamics; Humans; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Sclerosing Solutions; Sodium Pertechnetate Tc 99m

Sclerotherapy for esophageal varices was performed on six patients for a total of 16 injections. The sclerosant contained 5% ethanolamine oleate and technetium Tc 99m sodium pertechnetate solution at the volume ratio of 9:1. At each injection session 5 to 20 mL of this solution was injected into one varix. The distribution of the injected material was observed by a scintillation camera. Systemic dissemination of the sclerosant through the portal vein was demonstrated in five procedures, in which the injections were correctly intravenous. In three dogs 4 mL of 5% ethanolamine oleate made from oleic acids labeled with iodine 131 was injected into the gastric coronary vein. Most of the substance injected was washed out within five minutes, and systemic dissemination became evident.

Topics: Adult; Aged; Animals; Dogs; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Oleic Acids; Radionuclide Imaging; Sclerosing Solutions; Sodium Pertechnetate Tc 99m

The use of perchlorate to block gastric uptake of free 99Tcm-pertechnetate after in vivo labelling of red cells was investigated. In 19 out of 20 cases there was no evidence that previous administration of perchlorate adversely affected red cell labelling using commercial stannous agents. Adequate scintigraphic images of the vascular system could be obtained for up to 24 h after the cells were labelled. The technique was found to be of value in the investigation of sites of gastrointestinal bleeding.

Topics: Colon; Colonic Diseases; Erythrocytes; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Perchlorates; Radionuclide Imaging; Sodium Compounds; Sodium Pertechnetate Tc 99m; Stomach

Scintisplenoportography was performed on 33 occasions in 28 cirrhotic patients who had bled from esophagogastric varices. In 17 cases scintisplenoportography was carried out after a retroperitoneal distal splenorenal shunt procedure and in the remaining 16 instances in patients without any surgical shunt. In four patients scintisplenoportography was performed before and after a surgical shunt procedure, and in one case, before and after the shunt thrombosed. Gammagraphic patterns and spleen-heart times helped determine which patients did not have a surgical shunt, which had a patent shunt, and which patients had a thrombosed shunt. A patent shunt pattern and a thrombosed shunt pattern have been defined. It is concluded that scintisplenoportography is a useful, reproducible, and safe method to assess the patency of distal splenorenal shunts.

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Circulation; Liver Cirrhosis; Portasystemic Shunt, Surgical; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Splenorenal Shunt, Surgical; Technetium; Thrombosis; Time Factors