3445 A clinical study of the use of zoom video endoscopy for the monitoring of acute rejection in the small bowel allograft.

Abstract

Purpose of the Study: To evaluate the efficacy of magnification endoscopy for the monitoring of acute rejection in small bowel transplant recipients. Patients & Methods: A zoom video endoscope (PentaxEC-3830LZ) was used in 15 intestinal transplant recipients during 166 endoscopy sessions. This endoscope has the capability to magnify the endoscopic view up to 100 fold. With the magnification, the entire length of villi and crypt areas can be observed. All procedures were performed through surgical created ostomy except for one patient who received the procedure vua rectum. Results: Eighty-seven (52%) biopsies taken during the zoom endoscopy sessions were read as acute rejection by histological criteria including mild (n=70), moderate (n=14) and severe (n=3) rejections. Specific zoom endoscopic findings noted to correlate with the histological diagnosis of rejection were enlarged crypt areas (n=19), villus blunting (n=39), and flattening of villi (n=3). Rejections were successfully treated on all but two occasions with these changes seen on the zoom endoscopy returning to normal appearance. On 31 occasions, histologically diagnosed mild rejections were not treated based on normal findings on zoom endoscopy. These histological rejections all reversed without treatment. There were no complications associated with endscopies or biopsies. Conclusions: Zoom video endoscopy could clearly visualized the microscopic architecture of small bowel graft mucosa enabling the recognition of specific mucosal changes of rejection. We feel that an ability to more accurately assess the small bowel graft mucosa by this form of endoscopy enabled more timely initiation of the treatment of rejection and prevented unnecessary immunosuppression.