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

Lee, Kyung Jae; Choi, Shin Jie; Yang, Hye Ran; Chang, Ju Yuong; Kang, Hyoung Jin; Shin, Hee Young; Kang, Gyeong Hoon; Ko, Jae Sung; Moon, Jin Soo

doi:10.5223/pghn.2016.19.1.29

Cited by 13 publications

(30 citation statements)

References 22 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has also been demonstrated that very few diagnoses of isolated upper gastrointestinal acute GVHD would be missed by performing lower endoscopy alone 72 . Thus, owing to its diagnostic yield, safety and the non-requirement for sedation, flexible sigmoidoscopy with biopsy might be considered the initial endoscopic test of choice 73,74 . Notably, such an approach might not detect superimposed cytomegalo-virus infection, which might be scattered throughout the bowel or localized to the ascending colon 75 .…”

Section: Diagnosismentioning

confidence: 99%

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

View full text Add to dashboard Cite

Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomarkers have not yet been validated outside of clinical trials, endoscopic and histopathological evaluation continue to be utilized in diagnosis. Once a diagnosis of gastrointestinal acute GVHD is established, therapy with systemic corticosteroids is typically initiated, and non-responders can be treated with a wide range of second-line therapies. In addition to treating the underlying disease, the management of complications including profuse diarrhoea, severe malnutrition and gastrointestinal bleeding is paramount. In this Review, we discuss strategies for the diagnosis and management of acute GVHD of the gastrointestinal tract as they pertain to the practising gastroenterologist.

show abstract

Section: Diagnosismentioning

confidence: 99%

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

View full text Add to dashboard Cite

show abstract

“…A retrospective cohort study including 18 lower GI endoscopies in children concluded that sigmoidoscopy is the procedure of choice; however, this study included only two biopsies from the right side of the colon and none from the TI. The author recommended considering a full colonoscopy if there is no evidence of GVHD on sigmoidoscopy 6 . In another retrospective study in pediatric patients, a rectal biopsy was suggested as appropriate for detection of GI GVH based on data from 14 lower endoscopy procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Recognizing possible safety and anesthesia‐related advantages of left‐side colonoscopy, 6,10 characteristics of patients were analyzed to predict whether a subpopulation might benefit from ileo‐colonoscopy while others may undergo only sigmoidoscopy.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of gastrointestinal symptoms in pediatric patients post hematopoietic stem cell transplantation: Ileo‐colonoscopy versus sigmoidoscopy. A single‐center experience and review of literature

Slae

Pinhasov

Davidovics

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background Hematopoietic stem cell transplantation (HSCT) is a curative therapy used to treat high‐risk hematological malignant disorders and other life‐threatening nonmalignant diseases. Gastrointestinal (GI) symptoms post‐HSCT might be due to GI graft‐versus‐host disease (GVHD) or GI infections or both. GI endoscopy with biopsies is safe and beneficial in guiding the management of GI symptoms in children after HSCT, justifying the therapeutic management and contributing to improved outcomes. Methods A retrospective cohort study including 16 children with malignant and nonmalignant diseases that underwent allogeneic HSCT who had 24 ileo‐colonoscopies performed for GI symptoms. To facilitate an evidence‐based approach to the endoscopic evaluation of GI symptoms in pediatric patients post HSCT, we examined whether a full ileo‐colonoscopy, which includes right colon and terminal ileum (TI), as opposed to a limited sigmoidoscopy, was more accurate in the evaluation of GI symptoms in pediatric patients post HSCT. Results Specific findings on the right colon/TI were found in nine out of 24 ileo‐colonoscopies (38%, CI = 19%–59%). The macroscopic findings on ileo‐colonoscopy were compared with the histopathologic findings. When macroscopic findings were present, there were matching histopathologic findings in 100% of cases. However, even in the absence of any macroscopic findings on ileo‐colonoscopy, there were histopathological findings in 29% of the cases (p‐value = .016). Conclusions This cohort favors ileo‐colonoscopy over sigmoidoscopy, with systematic biopsy sampling, in evaluating GI symptoms in pediatric patients post HSCT.

show abstract

“…These data suggest that when using this approach, GI-GVHD can be histologically identified in 60% to 88% of patients, with greater yield in lower endoscopy (80% to 90%) compared with upper endoscopy (60% to 70%) and greatest yield in combination upper and lower endoscopy (>90%). Retrospective data, assessing endoscopy performed only in the presence of clinical suspicion, demonstrate diagnostic yields in upper (27% to 84%) and lower endoscopy (50% to 80%) generally less than those seen in the prospective trials [7][8][9][10]. Whether the greater diagnostic yield of histologic GVHD identified in prospective trials correlates with improved response to anti-GVHD treatment or survival remains unknown.…”

Section: Introductionmentioning

confidence: 96%

Diagnostic Utility of Endoscopy and Biopsy in Suspected Acute Gastrointestinal Graft-versus-Host Disease after Hematopoietic Progenitor Cell Transplantation

Scott

Tey

Butler

et al. 2018

Biology of Blood and Marrow Transplantation

View full text Add to dashboard Cite

Acute gastrointestinal graft-versus-host disease (GI-GVHD) after hematopoietic progenitor cell transplantation (HPCT) is a common and life-threatening complication. Endoscopic biopsy of the GI tract (GIT) is required for diagnosis. However, clear evidence to optimize this diagnostic approach is lacking, leading to variation in diagnostic sensitivity between institutions. We aimed to assess the clinical, endoscopic, and histologic findings of endoscopies performed for suspected acute GI-GVHD at our institution to better define the optimal use of this strategy. We performed a retrospective cohort study of adults who had undergone endoscopy for suspected acute GI-GVHD within 180 days after allogeneic HPCT for hematologic malignancy between 2011 and 2016. Details included symptoms at time of referral for endoscopy, type of procedure performed, macroscopic findings on endoscopy, and histologic findings after gut biopsy. Correlation was made with clinical GVHD severity scores. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and compared for each procedure. Predictors of histologic GVHD and overall survival were also compared. Of the 123 patients included, acute GI-GVHD occurred in 59 (48%). Lower endoscopy demonstrated greater sensitivity than upper endoscopy (50% versus 39%). Single upper endoscopy for upper symptoms alone had the lowest yield of GI-GVHD (14%). Combination upper and lower endoscopy demonstrated strong histologic concordance between upper and lower procedures. The addition of upper endoscopy to lower endoscopy only identified an extra 2 (4%) cases of GVHD. Advanced age and the presence of lower GIT symptoms were the only pre-endoscopy predictors of histologic GVHD on multivariate analysis. Patients with isolated upper histologic GVHD showed similar survival to patients with negative biopsies. Endoscopy and biopsy only identified 74% of those ultimately requiring treatment for acute GI-GVHD. Acute GI-GVHD remains a clinical diagnosis supported by available histologic evidence. Isolated upper GI-GVHD is rare, and in the absence of lower GIT symptoms, routine upper endoscopy does not significantly improve diagnostic yield for histologic GVHD. Overall, endoscopy and biopsy underdiagnoses 26% of clinical GI-GVHD, highlighting a need for research into novel diagnostic strategies.

show abstract

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

Cited by 13 publications

References 22 publications

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Evaluation of gastrointestinal symptoms in pediatric patients post hematopoietic stem cell transplantation: Ileo‐colonoscopy versus sigmoidoscopy. A single‐center experience and review of literature

Diagnostic Utility of Endoscopy and Biopsy in Suspected Acute Gastrointestinal Graft-versus-Host Disease after Hematopoietic Progenitor Cell Transplantation

Contact Info

Product

Resources

About