Diagnostic endoscopy in children after hematopoietic stem cell transplantation

Objective To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT). Design Data from 191 patients was reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prev...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2006-09, Vol.64 (3), p.379-385
Main Authors: Khan, Khalid, MBCHB, Schwarzenberg, Sarah Jane, MD, Sharp, Harvey, MD, Jessurun, Jose, MD, Gulbahce, H. Evin, DeFor, Todd, MS, Nagarajan, Rajaram, MD, MS
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bone marrow, stem cells transplantation. Graft versus host reaction
Child
Child, Preschool
Endoscopy, Gastrointestinal - adverse effects
Endoscopy, Gastrointestinal - methods
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal Diseases - diagnosis
Gastrointestinal Diseases - etiology
Graft vs Host Disease - diagnosis
Graft vs Host Disease - etiology
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
Infant
Male
Medical sciences
Retrospective Studies
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
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Summary:Objective To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT). Design Data from 191 patients was reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prevalence of acute graft-versus-host disease [GVHD] are highest) and those performed beyond 100 days. Results Visible endoscopic lesions were found in 63 of 198 (32%) esophagogastroduodenoscopies (EGDs) and 36 of 220 (16%) sigmoidoscopies. Histology Acute GVHD was present in 38 of 121 (31%) biopsy specimens from EGDs within the first 100 days, 15 of 73 (21%) samples from EGDs after 100 days, 52 of 136 (38%) sigmoid biopsy specimens before 100 days, and in 25 of 82 (31%) samples after 100 days. Non-GVHD histologic abnormalities were present in 36 of 124 (29%) biopsy samples from EGDs before 100 days, 32 of 74 (43%) specimens after 100 days, 14 of 136 (10%) sigmoid specimens before 100 days, and 11 of 84 (13%) samples beyond 100 days. Complications Complications occurred in 13 procedures (3.1%): eight (4.2%) EGDs, four (2.0%) sigmoidoscopies, and one (5.5%) colonoscopy. Intestinal bleeding occurred in 12 of the 13 procedures. Thrombocytopenia was a statistically significant association ( p < 0.01). One death occurred after splenic flexure perforation. Conclusions GI abnormalities other than acute GVHD occurred in children after HSCT. Acute GVHD was diagnosed most commonly on sigmoid biopsy. Postprocedure hemorrhage was related to thrombocytopenia.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2005.08.040