Sugihara Yuusaku, Hiraoka Sakiko, Yasutomi Eriko, Oka Shohei, Yamasaki Yasushi, Inokuchi Toshihiro, Kinugasa Hideaki, Takahara Masahiro, Morito Yuki, Takahashi Sakuma, Harada Keita, Tanaka Takehiro, Otsuka Fumio, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Exp Ther Med. 2020 Apr;19(4):3076-3080. doi: 10.3892/etm.2020.8538. Epub 2020 Feb 21.
Intestinal graft-vs.-host disease (GVHD) is a serious complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Villous atrophy in the terminal ileum is considered a useful diagnostic indicator for GVHD. However, the inter- and intra-observer agreement regarding the ileocolonoscopic findings indicative of acute intestinal GVHD, i.e., villous atrophy in the terminal ileum, are currently insufficient in multiple institutions. Thus, the present study aimed to investigate the incidence of villous atrophy in the terminal ileum to diagnose acute intestinal GVHD and determine the inter- and intra-observer agreement regarding this result for experienced endoscopists from multiple institutions. Consecutive patients who underwent allo-HSCT were referred to our institution between May 2008 and September 2015. A total of 54 patients underwent total ileocolonoscopy after allo-HSCT due to suspected intestinal acute GVHD. Subsequently, three observers from different institutions evaluated the cases for the presence of villous atrophy in the terminal ileum. In this study, the pathology results were a gold standard to evaluate the predictive value of ileocolonoscopy detection. Definitive pathological and non-pathological GVHD was diagnosed in 22 and 32 cases, respectively. The results of examining whether villous atrophy could predict GVHD were as follows. For three observers (A, B and C), the sensitivity of villous atrophy in the terminal ileum was 86.4, 77.3 and 79.2%, respectively, whereas the specificity was 62.5, 62.5 and 86.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of villous atrophy for GVHD were as follows: The PPV of appearance was 61.3, 58.6 and 82.6%, respectively, whereas the NPV was 87.0, 80.0 and 83.9%, respectively. Kappa coefficients for the inter-observer reliability were 0.85, 0.63 and 0.63 for observers A and B, A and C, and B and C, respectively. The intra-observer kappa coefficient was 0.88 for observer A, 0.73 for observer B and 0.75 for observer C. A substantial observer agreement was achieved for the analysis of villous atrophy in the terminal ileum and the agreement for the predictive histological diagnosis was also excellent. Based on the results of the present study, identification of villous atrophy in the terminal ileum was a clinically effective diagnostic parameter, even if different endoscopists were involved in the diagnosis at multiple institutions. The present study was registered as a trial with the University Hospital Medical Information Network (UMIN; registration no. UMIN000025390).
肠道移植物抗宿主病（GVHD）是异基因造血干细胞移植（allo-HSCT）的一种严重并发症。回肠末端的绒毛萎缩被认为是GVHD的一个有用诊断指标。然而，目前多个机构中，关于提示急性肠道GVHD的回结肠镜检查结果（即回肠末端绒毛萎缩）的观察者间和观察者内一致性不足。因此，本研究旨在调查回肠末端绒毛萎缩的发生率以诊断急性肠道GVHD，并确定多个机构经验丰富的内镜医师对此结果的观察者间和观察者内一致性。2008年5月至2015年9月期间，接受allo-HSCT的连续患者被转诊至我院。共有54例因疑似肠道急性GVHD接受allo-HSCT后的患者接受了全回结肠镜检查。随后，来自不同机构的三名观察者评估这些病例回肠末端绒毛萎缩的情况。在本研究中，病理结果是评估回结肠镜检查检测预测价值的金标准。分别在22例和32例中确诊了明确的病理性和非病理性GVHD。回肠末端绒毛萎缩能否预测GVHD的检查结果如下。对于三名观察者（A、B和C），回肠末端绒毛萎缩的敏感性分别为86.4%、77.3%和79.2%，而特异性分别为62.5%、62.5%和86.7%。绒毛萎缩对GVHD的阳性预测值（PPV）和阴性预测值（NPV）如下：外观的PPV分别为61.3%、58.6%和82.6%，而NPV分别为87.0%、80.0%和83.9%。观察者A和B、A和C以及B和C之间观察者间可靠性的Kappa系数分别为0.85、0.63和0.63。观察者A的观察者内Kappa系数为0.88，观察者B为0.73，观察者C为0.75。对于回肠末端绒毛萎缩的分析达成了较高的观察者一致性，并且预测组织学诊断的一致性也很好。基于本研究结果，即使多个机构的不同内镜医师参与诊断，回肠末端绒毛萎缩的识别也是一个临床有效的诊断参数。本研究已在大学医院医学信息网络（UMIN；注册号UMIN000）注册为一项试验。 025390）
