P0616 SIMULTANEOUS UPPER AND LOWER ENDOSCOPY FOR THE DIAGNOSIS OF ACUTE GRAFT VERSUS HOST DISEASE

Abstract

Introduction: Endoscopic biopsy is the mainstay of diagnosis of acute graft versus host disease (aGVHD) in symptomatic individuals after hematopoietic stem cell transplant (HSCT). The site of biopsy is dependent on the patient’s symptoms. Despite their usefulness, endoscopic biopsies are not without risk. We propose that initial sigmoidoscopic biopsies would reduce the need for upper endoscopy. We examine endoscopic yield from upper endoscopy and sigmodoscopy for aGVHD. Methods: We have reviewed the pediatric endoscopy database at the University of Minnesota to identify children who have undergone both upper and lower GI procedures post-HSCT between 1995 and 2002. Only those who had a differential diagnosis of aGVHD were included. We compared sensitivity of total upper and lower performed and when performed simultaneously (on the same day). Chi-square was used for statistical comparison. Results: A total of 184 children median age 6.1 years age range 1–19 years (108 males) underwent 314 endoscopic sessions which resulted in a diagnosis of aGVHD in 107 cases. In 61 individuals 79 procedures were combined upper endoscopy and flexible sigmoidoscopy of which 32 were diagnosed with aGVHD. Overall aGVHD was found in 5/151 esophageal biopsies, 30/194 gastric and 39/183 duodenal biopsies. Of the total procedures performed upper procedures had a diagnosis of aGVHD in 53/198 and 81/216 had rectal biopsies positive for aGVHD. Where both procedures were performed at the same time aGVHD was diagnosed in 25/79 upper endoscopies; aGVHD was present in the esophagus in 3/63, stomach in 16/77, duodenum in 16/67 and rectum 22/78 biopsies. The overall sensitivities of upper endoscopy and flexible sigmoidoscopy were 53/107 (50%) and 81/107 (76%) respectively, p=0.00. In combination they were 25/32 (78%) and 22/32 (67%) respectively, p=0.40. Conclusion: Our data indicates that sigmoidoscopic biopsy is the most sensitive procedure for the diagnosis for acute GVHD. As it is the least invasive of all procedures it should be considered as the initial procedure for individuals being assessed for gastrointestinal symptoms and a strong likelihood of aGVHD.