Safety and Role of Gastrointestinal Endoscopy in the Management of Gastrointestinal Acute GVHD in Children After Hematopoietic Stem Cell Transplantation.

Abstract

Gastrointestinal (GI) endoscopy and biopsy is a common procedure to confirm the diagnosis of acute graft-versus-host disease (aGVHD) in children after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Its safety and benefits in aGVHD management is unclear. We aimed to review the safety and benefits of GI endoscopy and biopsy for GI-aGVHD management. From January 2000 to December 2009, 450 Children received allo-HSCT at SickKids. Seventy-nine (17.5%) patients underwent GI endoscopy and biopsy for suspicion of GI-aGVHD. GI-aGVHD grading was I (n=5), II (n=39), III (n=23), and IV (n=12). GI biopsy confirmed aGVHD in 49 (62%) patients and results were negative in 30 (38%). Thirty-two (40%) patients started treatment based on clinical criteria before procedure. Twenty-four out of 79 patients had a change in therapy because of biopsy results. Treatment change was significantly more common in patients who had a positive biopsy results compared with those with negative results (24/49 vs. 4/30, P=0.02). Comparing patients who started therapy before the biopsy results (n=32) and the remaining patients (n=47) who were not started on therapy, the biopsy results had more impact in altering/starting therapy in these patients (24/47 vs. 0/32, P<0.00001). For the 32 patients who started therapy before the procedure, the biopsy confirmed aGVHD diagnosis in 20 of them (63%). Only 1 patient (1.25%) had duodenal hematoma and needed prolong GI rest and ultimately recovered. GI endoscopy and biopsy was safe and useful in guiding therapy for GI-aGVHD.