Endoscopy 2019; 51(04): S204-S205
DOI: 10.1055/s-0039-1681779
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Clinical Endoscopic Practice ePosters
Georg Thieme Verlag KG Stuttgart · New York

DIAGNOSTIC YIELD OF ENDOSCOPY FOR PREDICTION OF ACUTE GRAFT VERSUS HOST DISEASE IN THE UPPER GASTROINTESTINAL TRACT

L Schulze
1   Interdisciplinary Endoscopy, University Medical Center Mainz, Mainz, Germany
,
A Kreft
2   Institute of Pathology, University Medical Center Mainz, Mainz, Germany
,
K Mönkemüller
3   Department of Gastroenterology, Helios Frankenwald, Kronach, Germany
,
PR Galle
1   Interdisciplinary Endoscopy, University Medical Center Mainz, Mainz, Germany
,
H Neumann
1   Interdisciplinary Endoscopy, University Medical Center Mainz, Mainz, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Intestinal graft-versus-host disease (GvHD) is a frequent complication after hematopoietic progenitor cell transplantation (HSCT) and biopsies are recommended for diagnosis. However, the best biopsy sites have yet not been clearly established and final histology results are often delayed as specific staining is required.

We aimed to assess the diagnostic yield of endoscopy for prediction of GvHD of the upper gastrointestinal tract. In addition, we aimed to determine the best sites for obtaining biopsies for diagnosis of GvHD.

Methods:

A large scaled retrospective cohort study was conducted. Patients diagnosed with acute GvHD in the upper gastrointestinal tract were included. Details included symptoms at time of referral for endoscopy, type of procedure performed, macroscopic findings on endoscopy, and histologic findings of biopsies obtained. Biopsies were graded with the Lerner score. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated.

Results:

A total of 101 patients (mean age 50.24, 44% female) underwent upper endoscopy and were diagnosed with intestinal GvHD. Mean Lerner-score was 2.0, 1.5, 1.5, and 1.8 for the esophagus, antrum, corpus and duodenum, respectively. Sensitivity, specificity, PPV and NPV for endoscopic prediction of GvHD were inconclusive and not significantly (P > 0.05) different between the esophagus (Sensitivity = 54%, Specificity = 62%, PPV = 45%, NPV = 70%), antrum (Sensitivity = 53%, Specificity = 66%, PPV = 42%, NPV = 75%), corpus (Sensitivity = 50%, Specificity = 54%, PPV = 40%, NPV = 64%) and duodenum (Sensitivity = 58%, Specificity = 83%, PPV = 83%, NPV = 58%).

Conclusions:

The diagnostic yield of endoscopy for prediction of acute GvHD in the upper gastrointestinal tract is considerable low and cannot replace histopathological evaluation. No specific biopsy side showed superior prediction of GvHD. Therefore, we recommend a stepwise biopsy-protocol for patients undergoing upper endoscopy for diagnosis of GvHD.