From Paediatric Gastroenterology, Noah's Ark Children's Hospital for Wales, Cardiff, UK.
Paediatric Oncology, University Hospital Southampton, Southampton, UK.
J Pediatr Gastroenterol Nutr. 2023 Apr 1;76(4):494-497. doi: 10.1097/MPG.0000000000003711. Epub 2023 Jan 23.
Diagnostic gastrointestinal (GI) endoscopy is used to differentiate GI graft versus host disease (GI-GvHD), which requires escalation of immunosuppressive treatment (IST), from other conditions such as viral infection, which may require reduction of IST. The aim of this study was to establish the clinical utility of GI endoscopy post hematopoietic stem cell transplant (HSCT) and the complication rate of these procedures.
This was a single-center observational retrospective cohort study. Hospital pediatric endoscopy and HSCT databases identified patients between January 2010 and December 2020. GI-GvHD was diagnosed if there were positive histological findings and clinical context. Data collected included demographics, timing of endoscopy post-HSCT, clinical utility, and complications of endoscopy. The endoscopy was deemed to be "clinically useful" if it resulted in a change of clinical management or helped to narrow down the differential diagnosis for the clinical team.
Three hundred thirty-nine HSCT occurred in 320 children during the study period. Sixty-six of 339 (19%) HSCT needed an "endoscopy episode." One hundred nineteen endoscopies were performed (53 concurrent upper and lower GI endoscopies, 11 upper GI endoscopies, and 2 lower GI endoscopies). Four of 119 (3%) endoscopies had complications: septic shock (1), duodenal hematoma (1), GI bleeding (1), and colonic perforation (1). Four patients had incomplete records to assess utility of endoscopy. Fifty-seven of 62 (92%) endoscopy episodes were "clinically useful," and 41 of 62 (66%) had a change in IST.
The clinical utility of endoscopy is high and in the majority of cases is associated with a change in patient management. Children post-HSCT are at high risk of complications from endoscopy; this should be made clear in the process of obtaining consent for procedures.
诊断性胃肠（GI）内镜用于区分需要升级免疫抑制治疗（IST）的 GI 移植物抗宿主病（GI-GvHD）与其他疾病，如病毒感染，后者可能需要减少 IST。本研究旨在确定造血干细胞移植（HSCT）后 GI 内镜的临床实用性及其操作的并发症发生率。
这是一项单中心观察性回顾性队列研究。医院儿科内镜和 HSCT 数据库确定了 2010 年 1 月至 2020 年 12 月期间的患者。如果存在阳性组织学发现和临床背景，则诊断为 GI-GvHD。收集的数据包括人口统计学特征、HSCT 后内镜检查的时间、临床实用性和内镜检查的并发症。如果内镜检查导致临床管理的改变或有助于缩小临床团队的鉴别诊断范围，则认为该内镜检查具有“临床意义”。
在研究期间，320 名儿童中有 339 名接受了 HSCT。339 例 HSCT 中有 66 例（19%）需要“内镜检查”。共进行了 119 次内镜检查（53 次上、下胃肠内镜检查，11 次上胃肠内镜检查，2 次下胃肠内镜检查）。4 例（3%）内镜检查出现并发症：感染性休克（1 例）、十二指肠血肿（1 例）、GI 出血（1 例）和结肠穿孔（1 例）。4 例患者的记录不完整，无法评估内镜检查的实用性。62 次内镜检查中有 57 次（92%）具有“临床意义”，41 次（66%）改变了 IST。
内镜检查的临床实用性很高，且在大多数情况下与患者管理的改变相关。HSCT 后儿童接受内镜检查的并发症风险较高；在获得程序同意时，应明确这一点。
