Significance of Colonoscopy in Patients with Intestinal Graft-Versus-Host Disease after Hematopoietic Stem Cell Transplantation

Abstract

Endoscopic and histological findings on distal colonoscopy are clinically significant in the diagnosis of intestinal GVHD, and limiting this examination to the distal section of the large intestine avoids causing further clinical deterioration in patients who are already in very poor general condition and the possibility of causing endoscopy-related complications.

Endoscopic Diagnosis of Pediatric Acute Gastrointestinal Graft‐Versus‐Host Disease

“…The median age was 8 years (range 0. [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Leukemias were the most common underlying diseases (71%) ( Table 1).…”

Pathology of graft-versus-host disease in the gastrointestinal tract

“…If rectal biopsy is negative but GI GVHD is still suspected, biopsy of the proximal GI tract (stomach or duodenum) may yield diagnostic material. There appears to be no advantage of taking additional biopsy specimens from the sigmoid colon or more proximal colon as these sites are generally concordant with rectal histologic examination [42,46]. Increased risk of bleeding has been reported after duodenal biopsies in children after HSCT [15], and accordingly, such biopsies are avoided when possible in some centers.…”

Diagnosis of Intestinal Graft-versus-Host Disease and Thrombotic Microangiopathy after Allogeneic Stem Cell Transplantation

“…Thus, we defined it as "possible TMA" if any two or more of the criteria, including increased LDH, thrombocytopenia, reticlocytosis and anemia without bleeding, RBC fragmentation > 1.2%, were observed (Table 2). Endoscopic findings suggestive of intestinal TMA include i) mucosal petechiae or ii) diffuse exfoliation, which would reflect ischemic colitis (Scowcroft et al 1981) ( Fig. 2A-e,f), whereas those of GVHD include i) mucosal edema, ii) loss of transparence of vascular pattern, and iii) mucosal defects visualized by indigo carmine stain (Cruz-Correa et al 2002;Oomori et al 2005) ( Fig. 2A-a,b).…”

“…A colonoscopy, including mucosal biopsies, was conducted for all patients as described previously (Oomori et al 2005). Patients complicating watery diarrhea (0.5 L/day or more) after HSCT were diagnosed as having TMA, GVHD or mixed type based on physical examination, laboratory and colonoscopic findings.…”