Site specific diagnostic yield of endoscopic biopsies in Gastrointestinal Graft-versus-Host Disease: A tertiary care Center experience.
Adult
Anatomic Variation
/ physiology
Biopsy
/ methods
Colon, Sigmoid
/ pathology
Duodenum
/ pathology
Endoscopy, Gastrointestinal
/ methods
Female
Gastrointestinal Diseases
/ diagnosis
Gastrointestinal Tract
/ pathology
Graft vs Host Disease
/ diagnosis
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Intestinal Mucosa
/ pathology
Male
Middle Aged
Rectum
/ pathology
Retrospective Studies
Tertiary Care Centers
Young Adult
acute GI GVHD
allogeneic hematopoietic SCT
endoscopic biopsies
Journal
Current research in translational medicine
ISSN: 2452-3186
Titre abrégé: Curr Res Transl Med
Pays: France
ID NLM: 101681234
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
04
06
2018
revised:
06
08
2018
accepted:
07
08
2018
pubmed:
13
9
2018
medline:
1
4
2020
entrez:
13
9
2018
Statut:
ppublish
Résumé
Gastrointestinal (GI) graft versus host disease (GVHD) occurs in up to 40% of patients undergoing allogenic hematopoietic stem cell transplantation (HSCT). However, the optimal endoscopic approach is still unclear and the area of the GI tract with the highest diagnostic yield is still a topic of debate. We compared the diagnostic yield of different anatomic site biopsies in the diagnosis of GI GVHD and assessed the correlation of endoscopic findings with histopathology. All cases of biopsy proven GI GVHD were obtained from pathology database AUBMC between 1/1/2005 and 31/8/2017. We retrospectively analyzed the demographical, clinical and endoscopic data. Nineteen patients were diagnosed with GI GVHD over 17.6 years. The most common presenting symptom was severe diarrhea (18 patients, 94.7%). Combining upper endoscopy and sigmoidoscopy with biopsies had the highest diagnostic yield of 90% in diagnosing GI GVHD compared to 63.6%, 78.6% and 77.8% for upper endoscopy, sigmoidoscopy and colonoscopy respectively. In macroscopically normal mucosa, the recto-sigmoid and duodenal biopsies had the highest diagnostic yield (75%). As for the macroscopically abnormal mucosa, the highest yield was for the recto-sigmoid biopsies (100%) in lower endoscopy and duodenal biopsies in the upper endoscopy (60%). In a patient suspected to have GI GVHD, the best endoscopic approach is the combination of upper endoscopy and flexible sigmoidoscopy with biopsies of normal as well as abnormal mucosa. It should be emphasized that normal mucosa be biopsied especially in the duodenum and recto-sigmoid for a better diagnostic yield.
Sections du résumé
BACKGROUND
Gastrointestinal (GI) graft versus host disease (GVHD) occurs in up to 40% of patients undergoing allogenic hematopoietic stem cell transplantation (HSCT). However, the optimal endoscopic approach is still unclear and the area of the GI tract with the highest diagnostic yield is still a topic of debate.
OBJECTIVE
We compared the diagnostic yield of different anatomic site biopsies in the diagnosis of GI GVHD and assessed the correlation of endoscopic findings with histopathology.
METHODS
All cases of biopsy proven GI GVHD were obtained from pathology database AUBMC between 1/1/2005 and 31/8/2017. We retrospectively analyzed the demographical, clinical and endoscopic data.
RESULTS
Nineteen patients were diagnosed with GI GVHD over 17.6 years. The most common presenting symptom was severe diarrhea (18 patients, 94.7%). Combining upper endoscopy and sigmoidoscopy with biopsies had the highest diagnostic yield of 90% in diagnosing GI GVHD compared to 63.6%, 78.6% and 77.8% for upper endoscopy, sigmoidoscopy and colonoscopy respectively. In macroscopically normal mucosa, the recto-sigmoid and duodenal biopsies had the highest diagnostic yield (75%). As for the macroscopically abnormal mucosa, the highest yield was for the recto-sigmoid biopsies (100%) in lower endoscopy and duodenal biopsies in the upper endoscopy (60%).
CONCLUSION
In a patient suspected to have GI GVHD, the best endoscopic approach is the combination of upper endoscopy and flexible sigmoidoscopy with biopsies of normal as well as abnormal mucosa. It should be emphasized that normal mucosa be biopsied especially in the duodenum and recto-sigmoid for a better diagnostic yield.
Identifiants
pubmed: 30206046
pii: S2452-3186(18)30036-9
doi: 10.1016/j.retram.2018.08.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
16-19Informations de copyright
Copyright © 2018 Elsevier Masson SAS. All rights reserved.