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Repeat Endoscopy Affects Patient Management in Gastrointestinal Graft-Versus-Host Disease
Journal article   Open access   Peer reviewed

Repeat Endoscopy Affects Patient Management in Gastrointestinal Graft-Versus-Host Disease

Ehsan Shabbir, Umar Farooq, Burhan Yanes and Margarida Magalhaes-Silverman
Clinical hematology international, Vol.2(2), pp.69-73
02/27/2020
DOI: 10.2991/chi.d.200220.001
PMCID: PMC8432351
PMID: 34595445
url
https://doi.org/10.2991/chi.d.200220.001View
Published (Version of record) Open Access

Abstract

Graft versus host disease (GVHD) of the gut is associated with significant morbidity and mortality after allogeneic hematopoietic cell transplant (allo-HCT). No guidelines exist regarding repeat endoscopy after failure of first-line treatment with steroids. We aimed to study if repeat endoscopic biopsy can be helpful in these patients to guide treatment decisions. We retrospectively reviewed medical records of all patients who underwent repeat endoscopy for clinical suspicion of gastrointestinal (GI) GVHD after allo-HCT. Of the 318 patients, 24 underwent endoscopy twice after allo-HCT. At first endoscopy, 20 patients (80%) showed abnormal findings: 16 with GVHD alone, 1 with GVHD plus cytomegalovirus (CMV), and 3 with GVHD plus infectious colitis. On repeat endoscopy in these 20 patients with GVHD, 6 showed improvement leading to de-escalation of therapy, 8 showed worsening of GVHD including detection of CMV in 2 patients, and 2 had no histological changes. One patient with simultaneous GVHD and CMV diagnosed on first biopsy, displayed significant improvement leading to de-escalation of therapy. Three patients with GVHD along with infectious colitis on biopsy subsequently showed improvement on repeat biopsy leading to de-escalation of therapy. Among 4 patients with normal findings on first endoscopy, 3 had GVHD and 1 had epstein-barrvirus-associated post-transplant lymphoproliferative disorder (EBV-PTLD) on repeat procedures. This study supports the usefulness of repeat endoscopy in persistently symptomatic patients when there is no improvement after the initial treatment based on the results of the first endoscopy. Repeat endoscopy may guide therapy without significant complications.
 Endoscopy Gastrointestinal graft versus host disease Hematopoietic Stem cell transplantation

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