Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-Versus-Host Disease.

Objectives: Gastrointestinal graft-versus-host disease (GI-GVHD) is a potentially life-threatening complication after hematopoietic stem cell transplantation. Symptoms indicating GI-GVHD motivates endoscopy with biopsy sampling and histopathological confirmation. However, optimal extent of endoscopy in children is presently unknown. Therefore, we aimed to evaluate if biopsies from the rectosigmoid area versus the rest of the colon/ileocolon with or without biopsies from simultaneous upper endoscopy, were equally reliable for detection of GI-GVHD and relevant differential diagnoses. Methods: Retrospective multicentre study based on histopathological re-evaluation of biopsies and hospital record data, collected from children with suspected GI-GVHD. Results: Forty-four children with 51 endoscopic occasions (81 procedures) were included. Thirty-nine of 51 (76.5%) were diagnosed as GI-GVHD, 14 (27.4%) received a differential diagnosis and 7 (13.7%) had normal histology findings. Co-morbidity, i.e. simultaneous detection of a differential diagnosis and GI-GVHD, was observed in 9 (23.1%) cases. CMV infection was the most frequent differential diagnosis, 6/7 were detected in biopsies from rectosigmoid- and esophagogastroduodenal areas. Sensitivity for detection of GI-GVHD in biopsies collected from rectosigmoid-ileocolonic-, rectosigmoid-, or esophagogastroduodenal areas were 97.4%, 84.6%, 83.3%, respectively, and 97.4% when the latter two were merged. The difference, non-detected GI-GVHD in the rectosigmoid area versus detected elsewhere in the GI tract, was statistically significant (p = 0.03). Conclusions: Biopsies collected from the rectosigmoid area solely, were not optimal for detection of paediatric GI-GVHD. However, when biopsy sampling from rectosigmoid- and upper GI tract areas were combined, the sensitivity for GI-GVHD was equally high as for ileocolonoscopy or full upper and lower endoscopy. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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