Varkey Jonas, Jonsson Viktor, Hessman Eva, De Lange Thomas, Hedenström Per, Oltean Mihai
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Sahlgrenska Intestinal Failure and Transplant Centre, Gothenburg, Sweden.
Scand J Gastroenterol. 2023 Jul-Dec;58(8):945-952. doi: 10.1080/00365521.2023.2175621. Epub 2023 Feb 5.
The gastrointestinal tract is the second most involved organ for graft-versus-host disease where involvement of the small intestine is present in 50% of the cases. Therefore, the use of a non-invasive investigation i.e., video capsule endoscopy (VCE) seems ideal in the diagnostic work-up, but this has never been systematically evaluated before.
The aim of this systematic review was to determine the efficacy and safety of VCE, in comparison with conventional endoscopy in patients who received hematopoietic stem cell transplantation.
Databases searched were PubMed, Scopus, EMBASE, and Cochrane CENTRAL. All databases were searched from their inception date until June 17, 2022. The search identified 792 publications, of which 8 studies were included in our analysis comprising of 232 unique patients. Efficacy was calculated in comparison with the golden standard i.e., histology. Risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
The pooled sensitivity was higher for VCE at 0.77 (95% CI: 0.60-0.89) compared to conventional endoscopy 0.62 (95% CI: 0.47-0.75) but the difference was not statistically significant ( = 0.155, = 2.02). Similarly, the pooled specificity was higher for VCE at 0.68 (95% CI: 0.46-0.84) than for conventional endoscopy at 0.58 (95% CI: 0.40-0.74) but not statistically significant ( = 0.457, = 0.55). Moreover, concern for adverse events such as intestinal obstruction or perforation was not justified since none of the capsules were retained in the small bowel and no perforations occurred in relation to VCE. A limitation to the study is the retrospective approach seen in 50% of the studies.
The role of video capsule endoscopy in diagnosing or dismissing graft-versus-host disease is not yet established and requires further studies. However, the modality appears safe in this cohort.
胃肠道是移植物抗宿主病中第二常受累的器官，其中50%的病例存在小肠受累。因此，使用非侵入性检查，即视频胶囊内镜检查（VCE），在诊断检查中似乎是理想的，但此前从未进行过系统评估。
本系统评价的目的是确定与传统内镜检查相比，VCE在接受造血干细胞移植患者中的有效性和安全性。
检索的数据库有PubMed、Scopus、EMBASE和Cochrane CENTRAL。所有数据库从其创建日期开始检索，直至2022年6月17日。检索到792篇出版物，其中8项研究纳入我们的分析，包括232例独特患者。与金标准即组织学相比计算有效性。使用诊断准确性研究质量评估-2工具进行偏倚风险评估。
VCE的合并敏感度为0.77（95%CI：0.60 - 0.89），高于传统内镜检查的0.62（95%CI：0.47 - 0.75），但差异无统计学意义（P = 0.155，z = 2.02）。同样，VCE的合并特异度为0.68（95%CI：0.46 - 0.84），高于传统内镜检查的0.58（95%CI：0.40 - 0.74），但也无统计学意义（P = 0.457，z = 0.55）。此外，对肠梗阻或穿孔等不良事件的担忧没有依据，因为没有胶囊滞留在小肠中，且未发生与VCE相关的穿孔。该研究的一个局限性是50%的研究采用回顾性方法。
视频胶囊内镜在诊断或排除移植物抗宿主病中的作用尚未确立，需要进一步研究。然而，在该队列中该检查方式似乎是安全的。
