Diagnostic endoscopy in children after hematopoietic stem cell transplantation.
OBJECTIVE
To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT).


METHODS
Data from 191 patients were reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prevalence of acute graft-versus-host disease [GVHD] are highest) and those performed beyond 100 days.


RESULTS
Visible endoscopic lesions were found in 63 of 198 (32%) esophagogastroduodenoscopies (EGDs) and 36 of 220 (16%) sigmoidoscopies. Acute GVHD was present in 38 of 121 (31%) biopsy specimens from EGDs within the first 100 days, 15 of 73 (21%) samples from EGDs after 100 days, 52 of 136 (38%) sigmoid biopsy specimens before 100 days, and in 25 of 82 (31%) samples after 100 days. Non-GVHD histologic abnormalities were present in 36 of 124 (29%) biopsy samples from EGDs before 100 days, 32 of 74 (43%) specimens after 100 days, 14 of 136 (10%) sigmoid specimens before 100 days, and 11 of 84 (13%) samples beyond 100 days.


RESULTS
Complications occurred in 13 procedures (3.1%): 8 (4.2%) EGDs, 4 (2.0%) sigmoidoscopies, and 1 (5.5%) colonoscopy. Intestinal bleeding occurred in 12 of the 13 procedures. Thrombocytopenia was a statistically significant association (p < 0.01). One death occurred after splenic flexure perforation.


CONCLUSIONS
GI abnormalities other than acute GVHD occurred in children after HSCT. Acute GVHD was diagnosed most commonly on sigmoid biopsy. Postprocedure hemorrhage was related to thrombocytopenia.
Khan
Khalid
K
Department of Pediatrics, Division of Pediatric Gastroenterology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Schwarzenberg
Sarah Jane
SJ
Sharp
Harvey
H
Jessurun
Jose
J
Gulbahce
H Evin
HE
Defor
Todd
T
Nagarajan
Rajaram
R
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies