Impact of Small Bowel Exploration Using Video-Capsule Endoscopy in the Management of Acute Gastrointestinal Graft-versus-Host Disease.
BACKGROUND
The purpose of this study was to evaluate the impact of the global diagnostic approach on the outcome of patients suspected of having acute (a) gastrointestinal (GI) graft-versus-host disease (GVHD).


METHODS
Ten consecutive patients with suspected aGI-GVHD were prospectively explored with an exhaustive approach including video-capsule endoscopy (VCE). Images observed with VCE were compared with results obtained with other GI investigations including duodenal biopsies. RESULTS.: Five patients had a normal VCE examination: four were successfully treated symptomatically, but one died as a result of toxoplasmosis. VCE disclosed aGI-GVHD lesions in all five remaining patients, and two of the five were considered normal by upper GI endoscopy. All of these patients experienced improvement in their GI symptoms within 2 weeks of adjustments to their immunosuppressive treatment.


CONCLUSIONS
This approach has enhanced the authors' ability to adapt immunosuppressive treatments in patients suffering from suspected aGI-GVHD. Further investigation of the apparently high negative predictive value of VCE will be of great interest, particularly with a view to avoiding unnecessary immunosuppressive treatment.
Yakoub-Agha
Ibrahim
I
Service des Maladies du Sang, UAM d'Allogreffes de Cellule Souches Hématopoïétiques, CHRU de Lille, F-59037 Lille, France. yakoub-agha@chru-lille.fr
Maunoury
Vincent
V
Wacrenier
Agnés
A
Couignoux
Sandrine
S
Depil
Stéphane
S
Desreumaux
Pierre
P
Bauters
Francis
F
Colombel
Jean-Frédéric
JF
Jouet
Jean Pierre
JP
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006086:Graft vs Host Disease / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning