Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Rev Gastroenterol Mex (Engl Ed). 2021 Jul-Sep;86(3):215-219. doi: 10.1016/j.rgmxen.2021.05.004. Epub 2021 May 14.
Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD.
A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard.
Twenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively.
Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.
移植物抗宿主病（GvHD）是造血细胞移植的一种并发症，小肠是胃肠道的主要靶标之一。胶囊内镜是一种安全的检查方法，可用于 GvHD 的诊断。本研究旨在比较胶囊内镜与 GvHD 组织病理学发现的诊断效果。
本回顾性诊断测试研究纳入了 2015 年 7 月至 2019 年 7 月期间接受胃镜和结肠镜检查、活检组织病理学评估且同时进行胶囊内镜检查的疑似 GvHD 患者。将胶囊内镜检查结果与组织病理学诊断进行比较，后者被视为金标准。
21 例 GvHD 患者（7 例女性；37±11.9 岁）纳入本研究，其中 20 例（95%）为急性 GvHD。胶囊胃通过时间中位数为 55 分钟（20-113），小肠通过时间中位数为 261 分钟（238-434）。17 例（80.95%）通过胶囊内镜检查观察到整个小肠。组织病理学检查和胶囊内镜检查分别诊断出 17 例和 16 例 GvHD。组织病理学和胶囊内镜检查结果一致的有 18 例（15 例阳性，3 例阴性）。胶囊内镜检查的敏感性、特异性、阳性预测值、阴性预测值和诊断效能分别为 88%、75%、94%、60%和 85%。
胶囊内镜是一种安全的 GvHD 诊断工具，具有较高的敏感性和阳性预测值，与组织病理学发现具有中等一致性。
