title: Early detection of acute graft-versus-host disease by wireless capsule endoscopy and probe-based confocal laser endomicroscopy: results of a pilot study.
abstract: OBJECTIVE
  Acute gastrointestinal graft-versus-host disease (GI-GVHD) is usually diagnosed using endoscopic examinations and biopsies for conventional histology. The aim of this pilot study was to determine whether mini-invasive techniques such as probe-based confocal laser endomicroscopy (pCLE) combined with wireless capsule endoscopy (WCE) could detect early lesions of GI-GVHD prior to symptoms.
  
  
  METHODS
  Fifteen patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) were prospectively examined with a small bowel WCE, duodenal and colorectal pCLE, and standard biopsies. Per study protocol, all these examinations were scheduled between day 21 and day 28 after allo-HSCT, independently of the presence or absence of digestive symptoms.
  
  
  RESULTS
  During follow up, eight patients developed acute GI-GVHD. Sensitivity of WCE, pCLE, and histology were 50, 87.5, and 50%, respectively. Specificity of WCE, pCLE, and histology were 80, 71.5, and 80%, respectively. We showed a positive correlation between the Glücksberg scoring system and WCE (rho = 0.543, p = 0.036) and pCLE (rho = 0.727, p = 0.002) but not with standard histology (rho = 0.481, p = 0.069).
  
  
  CONCLUSIONS
  The results from this pilot study suggest that novel methods such as pCLE and WCE could be part of a mini-invasive algorithm for early detection of GI-GVHD.
authors.affiliation: Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France ; INSERM UMR 913, Université de Nantes, Nantes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.affiliation: Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Laurent
authors.affiliation: Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France ; CRNCA, UMR 892INSERM - 6299 CNRS, Nantes, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Malard
authors.affiliation: Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Le Rhun
authors.affiliation: Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Guillaume
authors.affiliation: CHU de Nantes, Laboratoire d'Anatomie-Pathologie, Nantes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mosnier
authors.affiliation: Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France ; INSERM UMR 913, Université de Nantes, Nantes, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.affiliation: Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France ; CRNCA, UMR 892INSERM - 6299 CNRS, Nantes, France ; Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
keywords: Early diagnosis; graft-versus-host disease; novel imaging techniques; probe-based confocal laser endomicroscopy; wireless capsule endoscopy