Pediatr Gastroenterol Hepatol Nutr.  2016 Mar;19(1):29-37. 10.5223/pghn.2016.19.1.29.

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

• KMID: 2160473
• DOI: http://doi.org/10.5223/pghn.2016.19.1.29

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.

Keyword

Graft-versus-host disease; Child; Endoscopy

MeSH Terms

Biopsy
Child
Colonoscopy
Duodenum
Endoscopy*
Esophagus
Graft vs Host Disease*
Hemorrhage
Humans
Seoul
Sigmoidoscopy*
Stem Cell Transplantation
Stomach

Figure

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  Fig. 1 Study flow.

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  Fig. 2 Cecum endoscopic findings of two patients. (A) It showed normal mucosa with graft-versus-host deisease (Patient 2–2). (B) It showed ulcer and exudate at endoscopy (Patient 12). Cytomegaloviral typhilitis was confirmed at histology.

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  Fig. 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).

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  Fig. 4 Serial rectosigmoidoscopic findings of the same patient (Patient 6). (A) It showed gross ulcer, exudates, and bleeding. The patient (Patient 6–1) was diagnosed as graft-versus-host disease (d20). However, steroid therapy failed to relieve his symptoms. (B) It showed d31 sigmoidoscopic finding of the same patient (Patient 6–2) showing exudates and bleeding. He was diagnosed as cytomegaloviral infection.

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  Fig. 5 Stepwise endoscopic approaches for pediatric gastrointestinal graft-versus-host disease (GVHD). EGD: esophagogastroduodenoscopy.

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