Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease

Background The small intestine is the most common location of intestinal graft-versus-host disease (GVHD). EGD with duodenal biopsies yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) is a nonin...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2007-03, Vol.65 (3), p.403-409
Main Authors: Neumann, Susanne, MD, Schoppmeyer, Konrad, MD, Lange, Thoralf, MD, Wiedmann, Marcus, MD, Golsong, Johannes, MD, Tannapfel, Andrea, MD, Mossner, Joachim, MD, Niederwieser, Dietger, MD, Caca, Karel, MD
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bone marrow, stem cells transplantation. Graft versus host reaction
Capsule Endoscopy - methods
Diagnosis, Differential
Digestive system. Abdomen
Endoscopy
Follow-Up Studies
Gastroenterology and Hepatology
Graft vs Host Disease - diagnosis
Graft vs Host Disease - etiology
Hematologic Neoplasms - surgery
Humans
Ileum - pathology
Intestinal Diseases - diagnosis
Intestinal Diseases - etiology
Investigative techniques, diagnostic techniques (general aspects)
Jejunum - pathology
Medical sciences
Peripheral Blood Stem Cell Transplantation - adverse effects
Predictive Value of Tests
Prospective Studies
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Transplantation, Homologous
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Summary:Background The small intestine is the most common location of intestinal graft-versus-host disease (GVHD). EGD with duodenal biopsies yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) is a noninvasive imaging procedure offering complete evaluation of the small intestine. Objective The objective was to compare the diagnostic value of EGD, including biopsies, with the results of WCE in patients with acute intestinal symptoms who received allogeneic blood stem cell transplantation and to analyze the appearance and distribution of acute intestinal GVHD lesions in these patients. Design An investigator-blinded, single-center prospective study. Patients Patients with acute intestinal symptoms after allogeneic stem cell transplantation underwent both EGD and WCE within 24 hours. Clinical data were recorded during 2 months of follow-up. Results Fourteen consecutive patients with clinical symptoms of acute intestinal GVHD were recruited. In 1 patient, the capsule remained in the stomach and was removed endoscopically. In 7 of 13 patients who could be evaluated, acute intestinal GVHD was diagnosed by EGD with biopsies, but 3 of these would have been missed by EGD alone. In all 7 patients with histologically confirmed acute intestinal GVHD, WCE revealed typical signs of GVHD. Lesions were scattered throughout the small intestine, but were most accentuated in the ileum. Limitations This study had a small number of patients. Conclusions WCE, which is less invasive than EGD with biopsies, showed a comparable sensitivity and a high negative predictive value for diagnosing acute intestinal GVHD. It may be helpful to avoid repeated endoscopic procedures in patients who have undergone stem cell transplantation.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2005.10.042