CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E281-E291
DOI: 10.1055/s-0043-122226
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Effective and less invasive diagnostic strategy for gastrointestinal GVHD

Katsuya Endo
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Fumiyoshi Fujishima
Department of Pathology, Tohoku University Hospital, Sendai, Japan
,
Masatake Kuroha
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Rintaro Moroi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Motoyuki Onodera
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Takeo Naito
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Yoshitake Kanazawa
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Tomoya Kimura
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Hisashi Shiga
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Yoichi Kakuta
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Yoshitaka Kinouchi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Tooru Shimosegawa
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
› Author Affiliations
Further Information

Publication History

submitted 28 March 2017

accepted after revision 31 August 2017

Publication Date:
01 March 2018 (online)

Abstract

Background and study aims Rectosigmoidoscopy with biopsy has been regarded to be a useful procedure to diagnose gastrointestinal graft-versus-host disease (GVHD). However, little is known about the specific colonoscopic features of gastrointestinal GVHD. In this study, we focused on the 4 unique colonoscopic findings – orange peel appearance, spotty redness, small mucosal sloughing, and diffuse mucosal defect – which are possible specific findings of gastrointestinal GVHD. We aimed to estimate the usefulness of these four unique colonoscopic findings in the rectosigmoid portion to diagnose gastrointestinal GVHD.

Patients and methods Seventy patients who were histologically diagnosed with gastrointestinal GVHD at our institute were retrospectively enrolled. Colonoscopic findings were reviewed, focusing on the four characteristic findings. The percentage of the positive cases for the characteristic findings was calculated. The final scoping portion and the number of cases showing any of the four characteristic findings in the rectosigmoid portion were also evaluated. The relationships between biopsy sites and the histological findings were also evaluated.

Results Orange peel appearance was observed in 66 cases (94.3 %). Spotty redness was observed in 45 cases (64.3 %). Small mucosal sloughing was observed in 49 cases (70.0 %). Diffuse mucosal defect was observed in six cases (8.6 %). The number of cases that were concurrently positive for one, two, and three findings were 16 (20.8 %), 20 (26.0 %), and 34 (48.6 %), respectively. Fifty-eight cases (82.9 %) were investigated up to the rectosigmoid portion, and 12 (17.1 %) were investigated beyond the sigmoid colon. All of the cases showed at least 1 of the 4 characteristics in the rectosigmoid portion. The percentage of crypt apoptosis in the biopsy specimen from orange peel appearance, spotty redness, small mucosal sloughing, and diffuse mucosal defect were 87.5 %, 83.3 %, 87.2 %, and 88.9 %, respectively.

Conclusion Orange peel appearance, spotty redness, small mucosal sloughing, and diffuse mucosal defect are the characteristic colonoscopic findings useful for diagnosis of gastrointestinal GVHD. These findings are frequently observed in the rectosigmoid portion. The histological detection rates for crypt cell apoptosis from these findings are high. Identifying the four characteristic findings on rectosigmoidoscopy and taking biopsies from these areas could be essential for the diagnostic strategy for gastrointestinal GVHD.