Repeat Endoscopy Affects Patient Management in Gastrointestinal Graft-Versus-Host Disease

Authors

Ehsan Shabbir^{1, 3, *,} , Umar Farooq^1, , Burhan Yanes², Margarida Magalhaes-Silverman¹

¹Department of Internal Medicine, Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

²Department of Hematology and Oncology, Wright State University, Dayton, Ohio, USA

³Department of Internal Medicine and Neurology, Wright State University, Dayton, Ohio, USA

^*Corresponding author. Email: ehsanshabbir@yahoo.com

DOI

10.2991/chi.d.200220.001How to use a DOI?

Keywords

Endoscopy; Gastrointestinal graft versus host disease; Hematopoietic; Stem cell transplantation

Abstract

Graft versus host disease (GVHD) of the gut is associated with significant morbidity and mortality after allogeneic hematopoietic cell transplant (allo-HCT). No guidelines exist regarding repeat endoscopy after failure of first-line treatment with steroids. We aimed to study if repeat endoscopic biopsy can be helpful in these patients to guide treatment decisions. We retrospectively reviewed medical records of all patients who underwent repeat endoscopy for clinical suspicion of gastrointestinal (GI) GVHD after allo-HCT. Of the 318 patients, 24 underwent endoscopy twice after allo-HCT. At first endoscopy, 20 patients (80%) showed abnormal findings: 16 with GVHD alone, 1 with GVHD plus cytomegalovirus (CMV), and 3 with GVHD plus infectious colitis. On repeat endoscopy in these 20 patients with GVHD, 6 showed improvement leading to de-escalation of therapy, 8 showed worsening of GVHD including detection of CMV in 2 patients, and 2 had no histological changes. One patient with simultaneous GVHD and CMV diagnosed on first biopsy, displayed significant improvement leading to de-escalation of therapy. Three patients with GVHD along with infectious colitis on biopsy subsequently showed improvement on repeat biopsy leading to de-escalation of therapy. Among 4 patients with normal findings on first endoscopy, 3 had GVHD and 1 had epstein-barrvirus-associated post-transplant lymphoproliferative disorder (EBV-PTLD) on repeat procedures. This study supports the usefulness of repeat endoscopy in persistently symptomatic patients when there is no improvement after the initial treatment based on the results of the first endoscopy. Repeat endoscopy may guide therapy without significant complications.

Copyright

© 2020 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Ehsan Shabbir
AU  - Umar Farooq
AU  - Burhan Yanes
AU  - Margarida Magalhaes-Silverman
PY  - 2020
DA  - 2020/02/27
TI  - Repeat Endoscopy Affects Patient Management in Gastrointestinal Graft-Versus-Host Disease
JO  - Clinical Hematology International
SP  - 69
EP  - 73
VL  - 2
IS  - 2
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.200220.001
DO  - 10.2991/chi.d.200220.001
ID  - Shabbir2020
ER  -