title: Endoscopic evaluation in gastrointestinal graft-versus-host disease: comparisons with histological findings.
abstract: The gastrointestinal (GI) tract is the major target site of the graft-versus-host disease (GVHD). Whether endoscopic findings can predict the histological diagnosis and degree of severity in GVHD remains controversial. We investigated the degree of correlation between endoscopic and histological findings, and evaluated the impact of endoscopic examination on clinical decision in GVHD management. This study was conducted as a retrospective single-center study. One hundred and one patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and at the risk of GI GVHD were referred for endoscopic evaluation. Endoscopic images and histology were reviewed to diagnose and grade in a blind fashion, and the histological findings were used as the "gold standard" for diagnosis. Endoscopic findings revealed a significantly positive association with histological abnormalities of GVHD (odds ratio [OR] = 33.6, 95% CI 4.3-261.1), and the sensitivity and specificity were 98 and 44%, respectively. The kappa coefficient for agreement between the endoscopic and histological grading was 0.423 (p-value < 0.001). Ten (18%) patients out of 57 histology-negative cases were managed successfully as GVHD on the endoscopic finding. Though the overall reliability of endoscopic diagnosis in GVHD is still insufficient in terms of sensitivity and specificity, high-grade cases such as grades 3 or 4 showed specific endoscopic findings to draw a significant agreement with histological findings. Endoscopic examination can give critical information and impose a pivotal impact on clinical decision when the histology is discordant with clinical presentation.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Cheung
authors.forename: Jin Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Soon Sub
authors.initials: SS
authors.lastname: Kim
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Sung
authors.forename: Se-Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Soo-Heon
authors.initials: SH
authors.lastname: Park
authors.forename: Joon-Yeol
authors.initials: JY
authors.lastname: Han
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Gyeong-Sin
authors.initials: GS
authors.lastname: Park
authors.forename: Chang Suk
authors.initials: CS
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult