title: Short article: Capsule endoscopy in graft-versus-host disease.
abstract: BACKGROUND
  The gold standard in the diagnosis of gastrointestinal graft-versus-host disease (GVHD) after allogenic hematopoietic stem cell transplantation is conventional endoscopy with histopathological assessment. The role of capsule endoscopy (CE) is uncertain. The aim of the present study was to investigate the accuracy of CE in this setting, comparing the clinical, endoscopic and histological data.
  
  
  METHODS
  This was a retrospective single-centre study that included 57 (mean age: 47.18±15.05 years, 57.89% men) patients presenting with GVHD who underwent a valid CE and histopathological analysis by conventional endoscopy between January 2004 and July 2016. The endoscopic scored findings, clinical data and histopathological diagnosis were compared using duodenal histology as the gold standard.
  
  
  RESULTS
  CE detected mild (n=4, 7.02%), moderate (n=6, 10.53%) and severe (n=21, 36.84%) grades, with a higher diagnostic yield than conventional endoscopy (54.39 vs. 28.07%, P<0.001). A positive CE predicted positive histology (80.64 vs. 15.38%, P<0.001) with a sensitivity, specificity, negative predictive value and accuracy of 86.21, 78.57, 84.62 and 82.46%. This procedure detected more mild-to-moderate histological lesions than conventional endoscopy (8.77 vs. 3.51%, P=0.25). In addition, 16% of patients with a previous normal endoscopy with biopsies had a pathological CE and there were eight (25.81%) patients with positive CE images unreachable by conventional endoscopy.
  
  
  CONCLUSIONS
  CE is a useful device in GVHD, achieving high accuracy values and diagnostic yield. However, its results may be interpreted in conjunction with clinical and histological features, particularly in mild-to-moderate stages.
authors.affiliation: aSmall Bowel Unit, Morales Meseguer Hospital bDepartment of Hematology and Medical Oncology, Morales Meseguer Hospital, Murcia, Spain cDepartment of Gastroenterology, Nantes University Hospital, Nantes, France.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado-Robles
authors.forename: Cristina
authors.initials: C
authors.lastname: Castilla-Llorente
authors.forename: Lucille
authors.initials: L
authors.lastname: Quénéhervé
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Higueras
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado-Martínez
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index