aGvHD,   cGvHD,  GvHD Prophylaxis

The diagnostic yield of endoscopy combined with tissue sampling in gastrointestinal graft-versus-host disease

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the most effective treatment option for hematological malignancies. Although supportive care for allo-HSCT has improved in recent years, graft-versus-host disease (GvHD) is still a severe, life threatening complication after transplantation. GvHD of the gastrointestinal tract (GI GvHD) can cause inferior mortality rates as well as worsen the patient’s systemic status, thus ensuring prompt diagnosis is mandatory.

To date, the optimal endoscopic approach is debated for GI GvHD patients, therefore Fady Daniel and colleagues compared the diagnostic yield of different anatomic site biopsies in the diagnosis of GI GvHD and evaluated the association between endoscopic findings and histopathology. The findings of this retrospective study were reported in Current Research in Translational Medicine.

Patients and methods
Key findings
  • The most common presenting symptom in 18/19 patients was severe diarrhea (94.7%), whilst upper gastrointestinal symptoms such as nausea and vomiting were observed in 5/19 patients (26.3%), 3/19 patients had a history of skin GvHD (15.8%)
  • Infectious causes of the diarrhea were not included such as Clostridium difficile infection
  • 17/19 patients were CMV seropositive (two recipient patients’ CMV status is unknown)
  • Combined upper endoscopy and sigmoidoscopy with biopsies showed the highest diagnostic yield in comparison with upper endoscopy, sigmoidoscopy and colonoscopy: 90% versus6%, 78.6% and 77.8%, respectively
  • The recto-sigmoid and duodenal biopsies had the highest diagnostic yield regarding macroscopically normal mucosa: 75%
  • Macroscopically abnormal mucosa biopsy had the highest yield in terms of recto-sigmoid biopsies (100%) in lower endoscopy, and duodenal biopsies in the upper endoscopy (60%)

Taken together, these results provide evidence that currently, the best endoscopic approach is the combination of upper endoscopy and flexible sigmoidoscopy with biopsies of normal and abnormal mucosa. The authors stated that “it should be emphasized that normal mucosa be biopsied especially in the duodenum and recto-sigmoid for a better diagnostic yield. All patients with suspected GI GvHD should be evaluated by endoscopy and tissue sampling.”

References
  1. Daniel F. et al. Site specific diagnostic yield of endoscopic biopsies in Gastrointestinal Graft-versus-Host Disease: A tertiary care Center experience. Curr Res Transl Med. 2018 Sep 8. DOI: 1016/j.retram.2018.08.001. [Epub ahead of print].
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