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Stepwise Endoscopy Based on Sigmoidoscopy in Evaluating Pediatric Graft-versus-Host Disease.

Lee KJ, Choi SJ, Yang HR, Chang JY, Kang HJ, Shin HY, Kang GH, Ko JS, Moon JS - Pediatr Gastroenterol Hepatol Nutr (2016)

Bottom Line: Fifteen patients with a total of 20 endoscopic procedures were included in our study.Sensitivity at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 80.0%, respectively.Negative predictive values at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 60.0%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The aim of our study was to establish a safe and convenient diagnostic method for acute gastrointestinal (GI) graft-versus-host disease (GVHD) in children by determining the sensitivity and negative predictive values of upper and lower endoscopic biopsies for children suspected of GI GVHD.

Methods: Patients suspected of GI GVHD who received endoscopic evaluation within 100 days after stem cell transplantation and endoscopies between January 2012 and March 2014 in Seoul National University Children's Hospital were included in our study.

Results: Fifteen patients with a total of 20 endoscopic procedures were included in our study. Sensitivity at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 80.0%, respectively. Negative predictive values at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 60.0%, respectively. Overall sensitivity and negative predictive values of upper endoscopic biopsy for GVHD were 77.8% and 50.0%, respectively. Overall sensitivity and negative predictive values of lower endoscopic biopsy for GVHD were 88.9% and 66.7%, respectively.

Conclusion: We recommend flexible sigmoidoscopy as a safe and accurate diagnostic tool for GVHD, similar to other studies reported previously. However, if there is no evidence of GVHD on sigmoidoscopy with high index of suspicion of GI bleeding, full colonoscopy and upper endoscopy should be considered.

No MeSH data available.


Related in: MedlinePlus

Duodenum of three patients. They showed grade 5 ulceration, exudate, and bleeding in endoscopy. (A) Graft-versus-host disease with ulcer (Patient 6–2). (B, C) Cytomegaloviral uodenitis (Patients 14 and 13).
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Figure 3: Duodenum of three patients. They showed grade 5 ulceration, exudate, and bleeding in endoscopy. (A) Graft-versus-host disease with ulcer (Patient 6–2). (B, C) Cytomegaloviral uodenitis (Patients 14 and 13).

Mentions: Table 5 shows endoscopic findings according to the Cruz-Correa's classification [11] and the presence of GVHD. There were several segments showing normal mucosa (Fig. 2A) in endoscopy. But there were GVHD in pathology results. The percentage of normal finding was 66.7% at the stomach, 25.0% at duodenum, 100% at cecum, 42.8% at colon, and 16.7% at rectosigmoid. On the other hand, 33.3–100% of non-GVHD patients showed severe ulceration, exudates, and bleeding on their endoscopy without pathologic diagnosis of GVHD. The pathologic findings in severe ulceration without GVHD was CMV typhilitis (Fig. 2B), duodenitis (Fig. 3B and 3C), and colitis (Fig. 4B). Other histologic findings in the severe ulceration segment were inflammatory granulation tissue, ulcer detritus, or acanthotic squamous epithelium.


Stepwise Endoscopy Based on Sigmoidoscopy in Evaluating Pediatric Graft-versus-Host Disease.

Lee KJ, Choi SJ, Yang HR, Chang JY, Kang HJ, Shin HY, Kang GH, Ko JS, Moon JS - Pediatr Gastroenterol Hepatol Nutr (2016)

Duodenum of three patients. They showed grade 5 ulceration, exudate, and bleeding in endoscopy. (A) Graft-versus-host disease with ulcer (Patient 6–2). (B, C) Cytomegaloviral uodenitis (Patients 14 and 13).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4821980&req=5

Figure 3: Duodenum of three patients. They showed grade 5 ulceration, exudate, and bleeding in endoscopy. (A) Graft-versus-host disease with ulcer (Patient 6–2). (B, C) Cytomegaloviral uodenitis (Patients 14 and 13).
Mentions: Table 5 shows endoscopic findings according to the Cruz-Correa's classification [11] and the presence of GVHD. There were several segments showing normal mucosa (Fig. 2A) in endoscopy. But there were GVHD in pathology results. The percentage of normal finding was 66.7% at the stomach, 25.0% at duodenum, 100% at cecum, 42.8% at colon, and 16.7% at rectosigmoid. On the other hand, 33.3–100% of non-GVHD patients showed severe ulceration, exudates, and bleeding on their endoscopy without pathologic diagnosis of GVHD. The pathologic findings in severe ulceration without GVHD was CMV typhilitis (Fig. 2B), duodenitis (Fig. 3B and 3C), and colitis (Fig. 4B). Other histologic findings in the severe ulceration segment were inflammatory granulation tissue, ulcer detritus, or acanthotic squamous epithelium.

Bottom Line: Fifteen patients with a total of 20 endoscopic procedures were included in our study.Sensitivity at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 80.0%, respectively.Negative predictive values at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 60.0%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The aim of our study was to establish a safe and convenient diagnostic method for acute gastrointestinal (GI) graft-versus-host disease (GVHD) in children by determining the sensitivity and negative predictive values of upper and lower endoscopic biopsies for children suspected of GI GVHD.

Methods: Patients suspected of GI GVHD who received endoscopic evaluation within 100 days after stem cell transplantation and endoscopies between January 2012 and March 2014 in Seoul National University Children's Hospital were included in our study.

Results: Fifteen patients with a total of 20 endoscopic procedures were included in our study. Sensitivity at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 80.0%, respectively. Negative predictive values at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 60.0%, respectively. Overall sensitivity and negative predictive values of upper endoscopic biopsy for GVHD were 77.8% and 50.0%, respectively. Overall sensitivity and negative predictive values of lower endoscopic biopsy for GVHD were 88.9% and 66.7%, respectively.

Conclusion: We recommend flexible sigmoidoscopy as a safe and accurate diagnostic tool for GVHD, similar to other studies reported previously. However, if there is no evidence of GVHD on sigmoidoscopy with high index of suspicion of GI bleeding, full colonoscopy and upper endoscopy should be considered.

No MeSH data available.


Related in: MedlinePlus