Zoom endoscopic evaluation of rejection in living-related small bowel transplantation.
BACKGROUND
This study evaluated zoom endoscopic findings according to four components in comparison with the histologic findings of acute cellular rejection (ACR) in a living-related small bowel transplantation (SBTx) patient.


METHODS
A 16-year-old boy with microvillus inclusion disease underwent SBTx with a 150-cm-long ileal graft from a blood-identical living-related donor. The endoscope was inserted into the distal stoma of the graft, and the mucosal architecture was observed under zoom. The observed findings were expressed by the following four components and graded as 0 to 2: H, homogeneity of mucosal change, minimal (H-0), patchy (H-1), diffuse (H-2); V, appearance of villi, stringlike (V-0), tonguelike (V-1), domelike (V-2); W, widening of crypt area, narrow (W-0), slightly widened within a width of one villus (W-1), markedly widened beyond a width of one villus (W-2); E, erythema in crypt area: no redness (E-0), sporadic erythema (E-1), diffuse erythema (E-2).


RESULTS
Histologic ACR was grade 0 in 27, grade 1 in 6, grade 2 in 3, and grade 3 in 0 occasions during 11 months after SBTx. In grade 0, 1, and 2 histology, H-0/H-1/H-2 was 85.2%/14.8%/0%, 33.3%/66.7%/0%, and 0%/100%/0%, respectively, with a significant difference among the groups by grade (P<0.05). V-0/V-1/V-2 was 48.1%/51.9%/0%, 0%/100%/0%, and 0%/66.7%/33.3% (P<0.05), W-0/W-1/W-2 was 85.2%/14.8%/0%, 0%/100%/0%, and 0%/66.7%/33.3% (P<0.05), and E-0/E-1/E-2 was 100%/0%/0%, 66.7%/33.3%/0%, and 0%/100%/0% (P<0.05), respectively.


CONCLUSIONS
Zoom endoscopic findings, graded on four components, may reflect the histologic severity of ACR and minimize the performance of biopsies in SBTx.
Sasaki
Takashi
T
Departments of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Hasegawa
Toshimichi
T
Nakai
Hiroshi
H
Kimura
Takuya
T
Okada
Akira
A
Musiake
Sohtarou
S
Doi
Reiko
R
D000293:Adolescent; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005190:Family; D005260:Female; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000637:transplantation*; D007963:Leukocytes, Mononuclear / Q000473:pathology; D019520:Living Donors; D008297:Male; D008875:Middle Aged