PURPOSE: The aim of our study was to establish a safe and convenient diagnostic
method for acute gastrointestinal (GI)
graft-versus-host disease (GVHD) in
children by determining the
sensitivity and
negative predictive values of upper and lower endoscopic
biopsies for
children suspected of GI GVHD.
METHODS: Patients suspected of GI GVHD
who received endoscopic evaluation within 100 days after
stem cell transplantation and endoscopies between January 2012 and March 2014 in
Seoul National
University Children 's
Hospital were included in our study.
RESULTS: Fifteen
patients with a total of 20 endoscopic
procedures were included in our study.
Sensitivity at the
esophagus ,
stomach , and
duodenum were 22.2%, 30.0%, and 80.0%, respectively.
Negative predictive values at the
esophagus ,
stomach , and
duodenum were 22.2%, 30.0%, and 60.0%, respectively. Overall
sensitivity and
negative predictive values of upper endoscopic
biopsy for GVHD were 77.8% and 50.0%, respectively. Overall
sensitivity and
negative predictive values of lower endoscopic
biopsy for GVHD were 88.9% and 66.7%, respectively.
CONCLUSION: We recommend flexible sigmoidoscopy as a safe and accurate diagnostic tool for GVHD,
similar to other studies reported previously. However, if there is no evidence of GVHD on sigmoidoscopy with high index of suspicion of GI
bleeding , full
colonoscopy and upper
endoscopy should be considered.