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Endoscopic Evaluation in Gastrointestinal Graft-Versus-Host Disease: Comparisons with Histological Findings

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Abstract

The gastrointestinal (GI) tract is the major target site of the graft-versus-host disease (GVHD). Whether endoscopic findings can predict the histological diagnosis and degree of severity in GVHD remains controversial. We investigated the degree of correlation between endoscopic and histological findings, and evaluated the impact of endoscopic examination on clinical decision in GVHD management. This study was conducted as a retrospective single-center study. One hundred and one patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and at the risk of GI GVHD were referred for endoscopic evaluation. Endoscopic images and histology were reviewed to diagnose and grade in a blind fashion, and the histological findings were used as the “gold standard” for diagnosis. Endoscopic findings revealed a significantly positive association with histological abnormalities of GVHD (odds ratio [OR] = 33.6, 95% CI 4.3–261.1), and the sensitivity and specificity were 98 and 44%, respectively. The kappa coefficient for agreement between the endoscopic and histological grading was 0.423 (p-value < 0.001). Ten (18%) patients out of 57 histology-negative cases were managed successfully as GVHD on the endoscopic finding. Though the overall reliability of endoscopic diagnosis in GVHD is still insufficient in terms of sensitivity and specificity, high-grade cases such as grades 3 or 4 showed specific endoscopic findings to draw a significant agreement with histological findings. Endoscopic examination can give critical information and impose a pivotal impact on clinical decision when the histology is discordant with clinical presentation.

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References

  1. Armitage JO (1994) Bone marrow transplantation. N Engl J Med 330:827–838. doi: 10.1056/NEJM199403243301206

    Article  PubMed  CAS  Google Scholar 

  2. Wagner JE Jr, Vogelsang GB, Beschorner WE (1989) Pathogenesis and pathology of graft-vs.-host disease. Am J Pediatr Hematol Oncol 11:196–212

    PubMed  Google Scholar 

  3. Sullivan KM (1999) Graft-versus-host disease. In: Thomas ED, Blume KB, Forman SJ (eds) Hematopoietic cell transplantation, 2nd edn. Blackwell Scientific Publications, Oxford, pp 515–536

    Google Scholar 

  4. Flowers ME, Kansu E, Sullivan KM (1999) Pathophysiology and treatment of graft-versus-host disease. Hematol Oncol Clin North Am 13:1091–1112. doi: 10.1016/S0889-8588(05)70111-8

    Article  PubMed  CAS  Google Scholar 

  5. Terdiman JP, Linker CA, Ries CA, Damon LE, Rugo HS, Ostroff JW (1996) The role of endoscopic evaluation in patients with suspected intestinal graft-versus-host disease after allogeneic bone-marrow transplantation. Endoscopy 28:680–685

    Article  PubMed  CAS  Google Scholar 

  6. Appleton AL, Sviland L, Pearson AD, Green MA, Eastham EJ, Malcolm AJ (1993) The need for endoscopic biopsy in the diagnosis of upper gastrointestinal graft-versus-host disease. J Pediatr Gastroenterol Nutr 16:183–185. doi: 10.1097/00005176-199302000-00015

    Article  PubMed  CAS  Google Scholar 

  7. Nishida T, Hamaguchi M, Hirabayashi N, Haneda M, Terakura S, Atsuta Y, Imagama S, Kanie T, Murata M, Taji H, Suzuki R, Morishita Y, Kodera Y (2004) Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease. Bone Marrow Transplant 33:1143–1150. doi: 10.1038/sj.bmt.1704512

    Article  PubMed  CAS  Google Scholar 

  8. Zeigler ZR, Shadduck RK, Nemunaitis J, Andrews DF, Rosenfeld CS (1995) Bone marrow transplant-associated thrombotic microangiopathy: a case series. Bone Marrow Transplant 15:247–253

    PubMed  CAS  Google Scholar 

  9. Cox GJ, Matsui SM, Lo RS, Hinds M, Bowden RA, Hackman RC, Meyer WG, Mori M, Tarr PI, Oshiro LS, Ludert JE, Meyers JD, McDonald GB (1994) Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 107:1398–1407

    PubMed  CAS  Google Scholar 

  10. Wu D, Hockenberry DM, Brentnall TA, Baehr PH, Ponec RJ, Kuver R, Tzung SP, Todaro JL, McDonald GB (1998) Persistent nausea and anorexia after marrow transplantation: a prospective study of 78 patients. Transplantation 66:1319–1324. doi: 10.1097/00007890-199811270-00010

    Article  PubMed  CAS  Google Scholar 

  11. Hackman RC, Wolford JL, Gleaves CA, Myerson D, Beauchamp MD, Meyers JD, McDonald GB (1994) Recognition and rapid diagnosis of upper gastrointestinal cytomegalovirus infection in marrow transplant recipients. A comparison of seven virologic methods. Transplantation 57:231–237. doi: 10.1097/00007890-199401001-00014

    Article  PubMed  CAS  Google Scholar 

  12. Cruz-Correa M, Poonawala A, Abraham SC, Wu TT, Zahurak M, Vogelsang G, Kalloo AN, Lee LA (2002) Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 34:808–813. doi: 10.1055/s-2002-34257

    Article  PubMed  CAS  Google Scholar 

  13. Ponec RJ, Hackman RC, McDonald GB (1999) Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation. Gastrointest Endosc 49:612–621. doi: 10.1016/S0016-5107(99)70390-1

    Article  PubMed  CAS  Google Scholar 

  14. Snover DC, Weisdorf SA, Vercellotti GM, Rank B, Hutton S, McGlave P (1985) A histopathologic study of gastric and small intestinal graft-versus-host disease following allogeneic bone marrow transplantation. Human Pathol 16:387–392. doi: 10.1016/S0046-8177(85)80232-X

    Article  CAS  Google Scholar 

  15. McDonald GB, Sale GE (1984) The human gastrointestinal tract after allogeneic marrow transplantation In: Sale GI, Shulman HM (eds) The pathology of bone marrow transplantation. Masson, New York, p 83

    Google Scholar 

  16. McDonald GB, Shulman HM, Sullivan KM, Spencer GD (1986) Intestinal and hepatic complications of human bone marrow transplantation. Part I. Gastroenterology 90:460–477

    PubMed  CAS  Google Scholar 

  17. Nydegger A, Catto-Smith AG, Tiedemann K, Hardikar W (2007) Diagnosis of gastrointestinal graft-versus-host disease—is rectal biopsy enough? Pediatr Blood Cancer 48:561–566. doi: 10.1002/pbc.20924

    Article  PubMed  Google Scholar 

  18. Thompson B, Salzman D, Steinhauer J, Lazenby AJ, Wilcox CM (2006) Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach. Bone Marrow Transplant 38:371–376. doi: 10.1038/sj.bmt.1705453

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

    Dae Young Cheung, Jin Il Kim, Soon Sub Kim, Hye Young Sung, Se-Hyun Cho, Soo-Heon Park, Joon-Yeol Han, Jae Kwang Kim, Jong-Wook Lee & Woo-Sung Min

  2. Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, St. Mary’s Hospital, 62 Youido-dong, Youngdeungpo-gu, Seoul, 150-173, The Republic of Korea

    Jin Il Kim

  3. Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea

    Gyeong-Sin Park & Chang Suk Kang

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  1. Dae Young Cheung
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  2. Jin Il Kim
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  3. Soon Sub Kim
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Correspondence to Jin Il Kim.

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Cheung, D.Y., Kim, J.I., Kim, S.S. et al. Endoscopic Evaluation in Gastrointestinal Graft-Versus-Host Disease: Comparisons with Histological Findings. Dig Dis Sci 53, 2947–2954 (2008). https://doi.org/10.1007/s10620-008-0262-6

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  • DOI: https://doi.org/10.1007/s10620-008-0262-6

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