Seeing what's out of sight: wireless capsule endoscopy's unique ability to visualize and accurately assess the severity of gastrointestinal graft-versus-host-disease.
Early recognition of gastrointestinal graft-versus-host disease (GI GVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT) is vital to initiation of therapy. However, the most common location, the small bowel (SB), is difficult to access with upper and lower endoscopy (UGE/LGE). Wireless capsule endoscopy (WCE) is a noninvasive technology allowing complete SB evaluation. The capsule location can also be tracked to identify motility derangements. From August 2006 to July 2007, 11 alloHSCT patients with GI symptoms underwent WCE, and visual grading was performed. UGE and LGE with biopsies were done when clinically indicated. All patients had evidence of probable acute GVHD (aGVHD) on WCE. WCE revealed lesions of greater severity than those seen by UGE or LGE in most patients. WCE demonstrated that 45% of patients had delayed gastric transit time. WCE is an excellent, noninvasive method for assessing GI GVHD, with the ability to more accurately assess the severity of GVHD, evaluate clinical symptoms, and follow response to treatment.
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Prakash
P
Varadarajan
Lauren M
LM
Dunford
Julie A
JA
Thomas
Karen
K
Brown
Pamela
P
Paplham
Margaret
M
Syta
Michael
M
Schiff
Swamithan
S
Padmanabhan
Minoo
M
Battiwalla
Shannon
S
Smiley
Theresa
T
Hahn
Philip L
PL
McCarthy
D000293:Adolescent; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods* / Q000592:standards; D003952:Diagnostic Imaging / Q000295:instrumentation*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D055815:Young Adult