Rajan Anand V, Trieu Harry, Chu Peiguo, Lin James, Kidambi Trilokesh Dey
Department of Medicine, City of Hope Medical Center, Duarte, CA 91010, United States.
World J Gastrointest Endosc. 2020 Oct 16;12(10):341-354. doi: 10.4253/wjge.v12.i10.341.
Acute gastrointestinal (GI) graft--host disease (aGVHD) is the most complication of hematopoietic stem cell transplant (HSCT) in patients with hematologic malignancy. Limited data exists on endoscopic evaluation of GVHD in post-HSCT patients with differing GI symptoms. Further, the diagnostic value of gross endoscopic findings as well as the safety of endoscopy in this commonly thrombocytopenic and neutropenic patient population remains unclear.
To understand the diagnostic value of symptoms and gross endoscopic findings as well as safety of endoscopy in aGVHD patients.
We analyzed 195 endoscopies performed at City of Hope in patients who underwent allogeneic HSCT less than 100 d prior for hematologic malignancy and were subsequently evaluated for aGVHD endoscopy. The yield, sensitivity, and specificity of diagnosing aGVHD were calculated for upper and lower endoscopy, various GI tract locations, and presenting symptoms.
Combined esophagogastroduodenoscopy (EGD) and flexible sigmoidoscopy (FS) demonstrated a greater diagnostic yield for aGVHD (83.1%) compared to EGD (66.7%) or FS (77.2%) alone with any presenting symptom. The upper and lower GI tract demonstrated similar yields regardless of whether patients presented with diarrhea (95.7% 99.1%) or nausea/vomiting (97.5% 96.8%). Normal-appearing mucosa was generally as specific (91.3%) as abnormal mucosa (58.7%-97.8%) for the presence of aGVHD. Adverse events such as bleeding (1.0%), infection (1.0%), and perforation (0.5%) only occurred in a small proportion of patients, with no significant differences in those with underlying thrombocytopenia ( = 1.000) and neutropenia ( = 0.425).
Combined EGD and FS with biopsies of normal and inflamed mucosa demonstrated the greatest diagnostic yield regardless of presenting symptom and appears to be safe in this population of patients.
急性胃肠道移植物抗宿主病（aGVHD）是血液系统恶性肿瘤患者造血干细胞移植（HSCT）最常见的并发症。关于HSCT术后出现不同胃肠道症状患者的GVHD内镜评估数据有限。此外，在这个普遍存在血小板减少和中性粒细胞减少的患者群体中，内镜大体检查结果的诊断价值以及内镜检查的安全性仍不明确。
了解症状和内镜大体检查结果在aGVHD患者中的诊断价值以及内镜检查的安全性。
我们分析了希望之城医院对195例患者进行的内镜检查，这些患者在接受异基因HSCT后不到100天因血液系统恶性肿瘤接受治疗，并随后接受了aGVHD内镜检查评估。计算了上消化道和下消化道内镜检查、胃肠道不同部位以及出现的症状对aGVHD的诊断阳性率、敏感性和特异性。
与单独进行食管胃十二指肠镜检查（EGD，阳性率66.7%）或乙状结肠镜检查（FS，阳性率77.2%）相比，联合EGD和FS对任何出现的症状的aGVHD诊断阳性率更高（83.1%）。无论患者表现为腹泻（95.7%对99.1%）还是恶心/呕吐（97.5%对96.8%），上消化道和下消化道的阳性率相似。对于aGVHD的存在，外观正常的黏膜通常与异常黏膜（58.7% - 97.8%）具有相似的特异性（91.3%）。出血（1.0%）、感染（1.0%）和穿孔（0.5%）等不良事件仅在一小部分患者中发生，在有血小板减少（P = 1.000）和中性粒细胞减少（P = 0.425）的患者中无显著差异。
联合EGD和FS并对正常和发炎黏膜进行活检，无论出现何种症状，诊断阳性率最高，且在这类患者中似乎是安全的。
