99mTc-Pertechnetate imaging for detection of ectopic gastric mucosa : A systema- tic review and meta-analysis of the pertinent literature

Background and aims : 99mTc-pertechnetate scintigraphy has long been used for detection of ectopic gastric mucosa (EGM) in the medical practice and evaluation of children with lower gastrointes- tinal bleeding. In the current study, we reviewed the available med- ical literature in this regard. Methods : Medline and SCOPUS were searched for relevant studies. Studies with sample size of at least 5 patients which pro- vided enough numerical data to calculate the sensitivity and/or specificity of 99mTc-pertechnetate for detection of EGM were includ- ed in the systematic review. Results : Overall 40 studies were included in our systematic re- view. Overall diagnostic indices of the 99mTc-pertechnetate scintig- raphy for EGM diagnosis were : sensitivity 92.1%[95%CI : 90.2- 93.8], specificity 95.4%[94.3-96.3], positive likelihood ratio 16.5[9.9-27.5], negative likelihood ratio 0.15[0.1-0.2], diagnostic odds ratio 120.7[73-199]. The pooled sensitivity was higher for studies using H2 blockers as a premedication (92.4% vs. 86.4%), studies using delayed imaging (94.3% vs. 88.4%), children (92.3% vs. 81.8%), and patients with gastrointestinal bleeding (95.3% vs. 75.3%). Conclusions : 99mTc-pertechnetate imaging is a highly accurate diagnostic modality for detection of EGM. This imaging is more accurate in children and patients presenting with gastrointestinal bleeding. Premedication with H2 blockers and delayed imaging can increase the diagnostic accuracy and should be routinely included in the imaging protocol. (Acta gastroenterol. belg., 2014, 77, 318- 327).