Capsule endoscopy as a diagnostic tool in the evaluation of graft‐vs.‐host disease

Abstract

Capsule endoscopy is a relatively new technology that has allowed gastroenterologists to visualize the mucosa of the small intestine. This technology is playing an expanding role in both adult and pediatric gastroenterology. In this report, we present an 8-yr-old child following allogeneic hematopoietic cell transplantation who developed large volume bloody diarrhea requiring multiple packed red blood cell transfusions that was resistant to aggressive therapy for GVHD. The capsule endoscopy performed on this patient provided significant information not provided by upper endoscopy and colonoscopy that allowed for successful treatment changes. This case demonstrates that capsule endoscopy is a diagnostic tool that may play an important role in the assessment of patients, including children, with possible GVHD.

Wireless capsule endoscopy in pediatric patients: the first series from Japan

“…Studies of adult patients have revealed that CE is superior to the small bowel series for evaluating the small intestine [1][2][3]. A number of recent studies on pediatric patients have demonstrated that CE is also a useful in children with abdominal complaints, although the application of CE in this patient population has received relatively less attention compared to the adult patient population [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The indications for CE in both children and adults include obscure gastrointestinal bleeding (OGIB), Crohn's disease (CD), and lymphangiectasia; in adults, suspected tumors of the small bowel also suggest the need for CE [9,[12][13][14].…”

Small bowel capsule endoscopy in 2007: Indications, risks and limitations

“…On the other hand May et al [77] clearly demonstrated that when chronic abdominal pain is associated with other signs or symptoms (weight loss > 10% of body weight, inflammation shown by laboratory tests, chronic anemia, or suspected mid-gastrointestinal bleeding) relevant, or potentially relevant, findings are diagnosed by capsule endoscopy in about 60% of cases. C a p s u l e e n d o s c o p y h a s a l s o b e e n u s e d , w i t h promising results, in other rare clinical conditions such as indeterminate colitis [78,79] , small bowel transplantation [80] , graft versus host disease [81,82] , protein losing entheropathy [83] , primitive lymphangectasia [84] (mostly in the pediatric population), Whipple disease [85] and irritable bowel syndrome (with clinical suspicion of celiac disease) [86] .…”

Wireless Capsule Endoscopy in Pediatric Gastrointestinal Diseases

“…A previous report demonstrated that CE contributed to identify the extent of the small intestinal involvement of HSP and confirmed the efficacy of cyclophosphamide therapy in improving the gastrointestinal lesions (Preud 'Homme DL, 2006). In regard to GVHD, a previous study reported that in an 8-yr old child following allogeneic hematopoietic cell transplantation who developed large volume bloody diarrhea requiring multiple blood transfusions that was resistant to aggressive therapy for GVHD, CE provided significant information not provided by upper endoscopy and colonoscopy that allowed for successful treatment changes (Silbermintz, 2006). Another study (Yakoub-Agha I, 2004) in adults demonstrated that CE provided more significant findings than upper endoscopy in the diagnosis of intestinal GVHD.…”

“…Thus, Growth failure with additional symptom might be included as an indication for CE. As an optional application, CE can be applied to evaluate the management of gastrointestinal diseases such as Henoch-Schonlein purpura (HSP) (Preud'Homme DL, 2006) and GVHD (Silbermintz, 2006;Yakoub-Agha I, 2004). In HSP, sastrointestinal bleeding occurs in ~50% of children, and massive bleeding may occur (Katz, 1991).…”