Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease.
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.
Neumann
Susanne
S
Department of Medicine I, Klinikum Ludwigsburg, Posilipoststrasse 4, 71640 Ludwigsburg, Germany.
Schoppmeyer
Konrad
K
Lange
Thoralf
T
Wiedmann
Marcus
M
Golsong
Johannes
J
Tannapfel
Andrea
A
Mossner
Joachim
J
Niederwieser
Dietger
D
Caca
Karel
K
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