GRAFT-VERSUS-HOST DISEASE

Abstract

Background: Graft-Versus-Host Disease (GVHD) remains a major barrier in pediatric allogenic Stem Cell Transplant (alloSCT). Endoscopic intestinal biopsies play a significant role in the diagnosis and treatment of gut GVHD. However, complications such as bleeding, hematoma and/or perforation occur in these immunosuppressed, neutropenic and thrombocytopenic patients, further compromising their disease status. Methods: After an IRB approval of protocol, we performed a retrospective chart review of post alloSCT recipients who are diagnosed with gut GVHD through endoscopies. Biopsies were evaluated by a single expert gastrointestinal pathologist to establish the significance of the biopsy sites in the overall diagnosis of gut GVHD. Results: We evaluated 59 combined EGD and lower endoscopies which were preformed in 45 patients between 24 and 100 days after alloSCT. A total of 57 duodenal biopsies were performed, of which 41 were diagnostic for GVHD representing a 72%. From the 59 stomach biopsies only 21 were diagnostic, representing only 36%. Only 37 of the 55 (67%) lower endoscopies explored the colon beyond the splenic flexure. Rectal biopsies were positive in 44 of the 58 biopsies (76%). However, when one combined an upper endoscopy with a flexible sigmoidoscopy 100% of all patients with GVHD were identified. Conclusions: In the upper endoscopies, duodenal biopsies are the most important for the diagnosis of GVHD. The combination of upper endoscopies and left side colonoscopies was diagnostic in 100% of the procedures.