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Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft-versus-host disease

Journal article
Authors T. Martensson
Karin Mellgren
J. Toporski
J. Arvidson
A. Szakos
T. H. Casswall
B. Gustafsson
Published in Clinical Transplantation
Pages 10
ISSN 0902-0063
Publication year 2020
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 10
Language en
Links dx.doi.org/10.1111/ctr.13867
Keywords children, endoscopy, gastrointestinal graft-versus-host disease, hematopoietic stem cell transplantation, histopathology, treatment, change, acute gvhd, diagnosis, association, management, criteria, Surgery, Transplantation
Subject categories Transplantation surgery

Abstract

Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft-versus-host disease (GI-GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI-GVHD (2000-2013) after receiving hematopoietic stem cell transplantation. Sixty-eight children with ninety-one endoscopic occasions were enrolled. At the time of endoscopy, anti-GI-GVHD treatment was ongoing in 71% (65/91). In 18% (12/65) with ongoing treatment, no histopathological evidence of GI-GVHD or another cause to justify anti-GI-GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re-endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (P = .007). Histopathological findings generating treatment changes were as follows: GI-GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI-GVHD.

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