Premedication in pediatric Meckel scintigraphy: pantoprazole versus ranitidine for optimizing scan quality.

Authors

Hasan Önner, Merve Ni̇da Calderon Tobar, Mehmet Sarıkaya, Fatma Özcan Sıkı, Fari̇se Yılmaz, Muslu Kazim Körez, Gonca Kara Gedi̇k

Published in

Pediatric radiology. Jun 14, 2025. Epub Jun 14, 2025.

Abstract

The standard method for diagnosing Meckel diverticulum and identifying ectopic gastric mucosa is ^{99 m}Tc-pertechnetate imaging. Premedication with H₂ receptor antagonists enhances the scan's sensitivity by reducing the washout of ^{99 m}Tc-pertechnetate activity from the intestinal lumen.
After the withdrawal of ranitidine, we compared the efficacy of the proton pump inhibitor pantoprazole as an alternative premedication agent for ^{99 m}Tc-pertechnetate Meckel diverticulum imaging.
This study assessed the scan quality of 141 children (aged 1 month to 204 months (median = 84 months)) who underwent Meckel scintigraphy over 10 years at a single institution. Before its withdrawal in December 2020, ranitidine was utilized for premedication, while pantoprazole was used thereafter. Therefore, patients were divided into two premedication groups: ranitidine (n = 88) and pantoprazole (n = 53). A high-quality scan was defined as having no ^{99 m}Tc-pertechnetate activity in the duodenal and other intestinal lumens. The effectiveness of pantoprazole in reducing ^{99 m}Tc-pertechnetate release in the duodenum and other intestinal lumens was compared to that of ranitidine. Differences in scan quality between the groups were analyzed using the two-proportion Z-test. In patients with positive scans, the lesion-to-background activity ratio of the Meckel diverticulum was measured and compared between the premedication groups.
Premedication with pantoprazole resulted in 47.2% of scans showing no ^{99 m}Tc-pertechnetate release, 37.7% with activity localized either in the duodenum or other intestine, and 15.1% exhibiting activity in both regions. In comparison, ranitidine resulted in 45.5% of scans with no ^{99 m}Tc-pertechnetate release, 40.9% with activity localized either in the duodenum or other intestine, and 13.6% showing activity in both regions. P-values were not found to be significant in all comparisons. Twelve scans were positive; all patients had Meckel diverticulum confirmed at surgery. For positive scans, the lesion-to-background activity ratio for the Meckel diverticulum was similar between the ranitidine and pantoprazole groups.
This study demonstrates that pantoprazole is statistically non-inferior to ranitidine regarding scan quality and lesion-to-background activity ratios for Meckel diverticulum detection. Pantoprazole offers a reliable alternative for clinical protocols in the absence of ranitidine.

PMID:
40515817
Bibliographic data and abstract were imported from PubMed on 15 Jun 2025.

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