Correlation of Endoscopic and Histological Grading in Acute Graft-Versus-Host Disease (GVHD) after Bone Marrow Transplantation

Abstract

Purpose: Graft-versus-host disease (GVHD) of the gastrointestinal tract is a major cause of morbidity and mortality after allogeneic bone marrow or stem cell transplantation. Whether macroscopic endoscopic grading predicts the histological staging of GVHD remains controversial. We reviewed the grading of endoscopic images in patients who were reported to have definite histological diagnosis of GVHD. This early endoscopic diagnosis could direct us to start specific therapy earlier and avoid the complication of endoscopic biopsies in severely thrombocytopenic patients. Methods: 41 patients, who had clinical and definite histological diagnosis of acute GVHD, had undergone endoscopic biopsies from gastric (34), duodenum (7) and Sigmoid (32). Endoscopic images of these patients were reviewed retrospectively since 2003 by 2 expert endoscopists. The endoscopic appearances of stomach, duodenum and Sigmoid were staged in four grades, according to the severity of macroscopic pictures. Correlations of four endoscopic grading (Brand RE et al, 1998) with four histological grading (McDonald and Sale, 1984) were compared, to determine the diagnostic accuracy in assessing the severity of GVHD. Statistical analysis of relationship was measured by Cohen's Kappa measure of agreement. Results: As the measure of agreement, grading between two techniques, endoscopic and histological, the Gastric measure was 0.579, moderate agreement (P < 0.0001) and sigmoid was 0.219, fair agreement (P < 0.010). Duodenal biopsies numbers were too small to get a significant relationship. Conclusion: Quite accurate early diagnosis and grading of acute GVHD could be obtained by the endoscopic images especially from the gastric and sigmoid, but histological evaluation is mandatory to exclude other causes of inflammation which give similar endoscopic images before committing for the final diagnosis of GVHD.