title: Enteroscopic biopsies in the management of pancreas transplants:  a proof of concept study for a novel monitoring tool.
abstract: BACKGROUND
  Although percutaneous biopsies are considered to be the gold standard in diagnosing pancreas graft rejection, they are not performed routinely because of their association with severe complications. On the other hand, correct diagnosis of rejection is essential but may be difficult in cases of enteric drainage, particularly in patients with a pancreas transplant alone or a pancreas after kidney transplant.
  
  
  METHODS
  Pancreas recipients who underwent enteroscopy between May 2005 and September 2009 were included in this retrospective analysis. Biopsies were graded 0 to 4 for interstitial and vascular changes.
  
  
  RESULTS
  During the study period a total of 65 simultaneous pancreas-kidney transplants, 13 pancreas after kidney transplants and 4 pancreas transplants alone were performed. Sixty-three patients underwent a single enteroscopy, 10 had two, and 6 had three or more. Indications were protocol graft monitoring (n=73), graft dysfunction (n=17), enteric hemorrhage (n=9), or other (n=3). The duodenal segment was accessed in 76 instances (75%) with abnormal findings in 23. A total of 69 biopsies were obtained and revealed normal mucosa in 49 cases (71%). Histology showed signs of acute rejection in 11 cases. The upper gastrointestinal tract was also assessed, and, in 13 cases, additional pathologies were identified including gastroduodenitis (n=10), gastric/duodenal ulcer (n=2), and hemorrhagic esophagitis (n=1). No procedure-related complication occurred.
  
  
  CONCLUSIONS
  This series of enteroscopies demonstrates that the duodenal segment of a pancreatic graft is accessible using our implant technique, and thus permitting biopsies to be obtained and endoscopic interventions to be performed.
authors: Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria. christian.margreiter@uki.at
authors: Christian
authors: C
authors: Margreiter
authors: Felix
authors: F
authors: Aigner
authors: Thomas
authors: T
authors: Resch
authors: Anna-Katharina
authors: AK
authors: Berenji
authors: Rupert
authors: R
authors: Oberhuber
authors: Robert
authors: R
authors: Sucher
authors: Christoph
authors: C
authors: Profanter
authors: Lothar
authors: L
authors: Veits
authors: Robert
authors: R
authors: Öllinger
authors: Raimund
authors: R
authors: Margreiter
authors: Johann
authors: J
authors: Pratschke
authors: Walter
authors: W
authors: Mark
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods*; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000502:physiology; D012189:Retrospective Studies; D055815:Young Adult