title: Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease.
abstract: BACKGROUND
  The small intestine is the most common location of intestinal graft-versus-host disease (GVHD). EGD with duodenal biopsies yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) is a noninvasive imaging procedure offering complete evaluation of the small intestine.
  
  
  OBJECTIVE
  The objective was to compare the diagnostic value of EGD, including biopsies, with the results of WCE in patients with acute intestinal symptoms who received allogeneic blood stem cell transplantation and to analyze the appearance and distribution of acute intestinal GVHD lesions in these patients.
  
  
  METHODS
  An investigator-blinded, single-center prospective study.
  
  
  METHODS
  Patients with acute intestinal symptoms after allogeneic stem cell transplantation underwent both EGD and WCE within 24 hours. Clinical data were recorded during 2 months of follow-up.
  
  
  RESULTS
  Fourteen consecutive patients with clinical symptoms of acute intestinal GVHD were recruited. In 1 patient, the capsule remained in the stomach and was removed endoscopically. In 7 of 13 patients who could be evaluated, acute intestinal GVHD was diagnosed by EGD with biopsies, but 3 of these would have been missed by EGD alone. In all 7 patients with histologically confirmed acute intestinal GVHD, WCE revealed typical signs of GVHD. Lesions were scattered throughout the small intestine, but were most accentuated in the ileum.
  
  
  CONCLUSIONS
  This study had a small number of patients.
  
  
  CONCLUSIONS
  WCE, which is less invasive than EGD with biopsies, showed a comparable sensitivity and a high negative predictive value for diagnosing acute intestinal GVHD. It may be helpful to avoid repeated endoscopic procedures in patients who have undergone stem cell transplantation.
authors.affiliation: Department of Medicine I, Klinikum Ludwigsburg, Posilipoststrasse 4, 71640 Ludwigsburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Neumann
authors.forename: Konrad
authors.initials: K
authors.lastname: Schoppmeyer
authors.forename: Thoralf
authors.initials: T
authors.lastname: Lange
authors.forename: Marcus
authors.initials: M
authors.lastname: Wiedmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Golsong
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Joachim
authors.initials: J
authors.lastname: Mossner
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
mesh_terms: D000208:Acute Disease; D000328:Adult; D053704:Capsule Endoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000209:etiology; D007583:Jejunum / Q000473:pathology*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014184:Transplantation, Homologous