TITLE:
Endoscopic Examination for Patients with Diarrhea after Allogeneic Stem Cell Transplantation
AUTHORS:
Junichi Kitagawa, Takuro Matsumoto, Yuhei Shibata, Nobuhiko Nakamura, Hiroshi Nakamura, Soranobu Ninomiya, Yasuhito Nannya, Masahito Shimizu, Takeshi Hara, Hiroshi Araki, Hisashi Tsurumi
KEYWORDS:
Intestinal GVHD, Endoscopic Evaluation, Ileoscopy, Colonoscopy
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.7 No.4,
November
3,
2017
ABSTRACT: Objective: Intestinal graft-versus-host disease (GVHD) represents one of the most serious
complications of allogeneic stem cell transplantation (allo-SCT). Endoscopic
and histological proof is required due to the number of differential diagnoses
manifesting as diarrhea. We investigated the safety of endoscopic biopsies, and
the role of conducting biopsies and inspections of the terminalileum. Patients: Thirty two colonoscopic
examinations and 29 biopsies were performed for 19 patients after allo-SCT in
our institute between October 2011 and May 2015. Results: Endoscopic
examinations and biopsies were performed safely under the policy of transfusing
platelets for thrombocytopenia (3/μL). For biopsied cases, the diagnostic
consistency rate with endoscopic findings was 60%, with a tendency toward
negative correlations with early
examinations after diarrhea onset (25% for 0 - 1 days; 62.5% for later)
or low-grade GVHD according to Freiburg criteria (41.2% for grade 1, 66.7% for
grade 2, 100% for higher). The terminal ileum was inspected with colonoscopy in 13 cases. Endoscopic diagnoses of the ileum were
provided in 11 cases and histological diagnoses in 9 cases. Diagnostic
consistency for diagnosis of the terminal
ileum between endoscopy and histology was 77.8%. Conclusion: Because endoscopic and histopathological findings do not always match, caution
is required when focusing on endoscopic findings alone, as there is a risk of
misdiagnosis. Extensive inspection of the terminal ileum with biopsy appears
useful to identify otherwise undetected lesions. Our data thus support invasive endoscopic examinations for
gastrointestinal complications, including ileac inspection and biopsies under
appropriate management.