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Dig Dis Sci. 2016 Mar;61(3):806-13. doi: 10.1007/s10620-015-3938-8. Epub 2015 Nov 4.

The Diagnostic Yield of Site and Symptom-Based Biopsies for Acute Gastrointestinal Graft-Versus-Host Disease: A 5-Year Retrospective Review.

Author information

1
Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA. daniel.wild@duke.edu.
2
Division of Hematology-Oncology, Duke Cancer Institute, Durham, NC, USA.
3
Division of Pathology, Duke University Medical Center, Durham, NC, USA.
4
Division of Biostatistics, Duke Cancer Institute, Durham, NC, USA.
5
Division of Gastroenterology, Harborview Medical Center, Seattle, WA, USA.
6
Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA.

Abstract

BACKGROUND:

Graft-versus-host disease (GVHD) complicates half of hematopoietic stem cell transplants (HCT), and the gastrointestinal tract is commonly affected. Endoscopic biopsies have a key role in the diagnosis. The optimal procedure(s) to perform and site(s) to biopsy remain unclear.

METHODS:

We retrospectively analyzed the charts of all adult patients who underwent allogeneic HCT at Duke University Medical Center between 1/1/05 and 1/1/11 and extracted data from those who underwent endoscopic biopsy for suspected GVHD. All histology was re-evaluated by blinded pathologists using 2006 NIH diagnostic criteria and then compared to the original clinical diagnosis of GVHD.

RESULTS:

A total of 169 adult patients underwent 250 endoscopic procedures to evaluate GVHD. The sensitivity of biopsies for clinical GVHD was 76 and 72% for upper and lower tract sites, respectively. In the presence of nausea, upper tract biopsies were positive for GVHD in 65%, 70% while lower tract biopsies were positive in 61-70%. In the presence of diarrhea, lower tract biopsies were positive in 65%, while upper tract sites were positive in 64-69%. Twenty six (40%) of the sixty-five endoscopies that simultaneously sampled upper and lower tract sites had discordant results. All were histologically positive for GVHD, yet 15% of upper tract biopsies and 25% of lower tract biopsies were negative.

CONCLUSIONS:

In this large review, the overall sensitivity of biopsies taken during EGD and Flex-Sig was 76 and 72%, respectively. A symptom-driven biopsy approach was not clearly supported as upper tract and lower tract biopsies were similarly diagnostic for GVHD regardless of symptoms.

KEYWORDS:

Endoscopic biopsies; Graft-versus-host disease; Hematopoietic stem cell transplant; Histology

PMID:
26537485
PMCID:
PMC4949071
[Available on 2017-03-01]
DOI:
10.1007/s10620-015-3938-8
[Indexed for MEDLINE]
Free PMC Article

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