Emmanuel Coron1, Valerie Laurent2, Florent Malard3, Marc Le Rhun2, Patrice Chevallier4, Thierry Guillaume4, Jean-François Mosnier5, Jean-Paul Galmiche1, Mohamad Mohty6. 1. Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France ; INSERM UMR 913, Université de Nantes, Nantes, France. 2. Institut des Maladies de l'Appareil Digestif, CHU and Université de Nantes, Nantes, France. 3. Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France ; CRNCA, UMR 892INSERM - 6299 CNRS, Nantes, France. 4. Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France. 5. CHU de Nantes, Laboratoire d'Anatomie-Pathologie, Nantes, France. 6. Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France ; CRNCA, UMR 892INSERM - 6299 CNRS, Nantes, France ; Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Abstract
OBJECTIVE: Acute gastrointestinal graft-versus-host disease (GI-GVHD) is usually diagnosed using endoscopic examinations and biopsies for conventional histology. The aim of this pilot study was to determine whether mini-invasive techniques such as probe-based confocal laser endomicroscopy (pCLE) combined with wireless capsule endoscopy (WCE) could detect early lesions of GI-GVHD prior to symptoms. DESIGN: Fifteen patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) were prospectively examined with a small bowel WCE, duodenal and colorectal pCLE, and standard biopsies. Per study protocol, all these examinations were scheduled between day 21 and day 28 after allo-HSCT, independently of the presence or absence of digestive symptoms. RESULTS: During follow up, eight patients developed acute GI-GVHD. Sensitivity of WCE, pCLE, and histology were 50, 87.5, and 50%, respectively. Specificity of WCE, pCLE, and histology were 80, 71.5, and 80%, respectively. We showed a positive correlation between the Glücksberg scoring system and WCE (rho = 0.543, p = 0.036) and pCLE (rho = 0.727, p = 0.002) but not with standard histology (rho = 0.481, p = 0.069). CONCLUSIONS: The results from this pilot study suggest that novel methods such as pCLE and WCE could be part of a mini-invasive algorithm for early detection of GI-GVHD.
OBJECTIVE: Acute gastrointestinal graft-versus-host disease (GI-GVHD) is usually diagnosed using endoscopic examinations and biopsies for conventional histology. The aim of this pilot study was to determine whether mini-invasive techniques such as probe-based confocal laser endomicroscopy (pCLE) combined with wireless capsule endoscopy (WCE) could detect early lesions of GI-GVHD prior to symptoms. DESIGN: Fifteen patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) were prospectively examined with a small bowel WCE, duodenal and colorectal pCLE, and standard biopsies. Per study protocol, all these examinations were scheduled between day 21 and day 28 after allo-HSCT, independently of the presence or absence of digestive symptoms. RESULTS: During follow up, eight patients developed acute GI-GVHD. Sensitivity of WCE, pCLE, and histology were 50, 87.5, and 50%, respectively. Specificity of WCE, pCLE, and histology were 80, 71.5, and 80%, respectively. We showed a positive correlation between the Glücksberg scoring system and WCE (rho = 0.543, p = 0.036) and pCLE (rho = 0.727, p = 0.002) but not with standard histology (rho = 0.481, p = 0.069). CONCLUSIONS: The results from this pilot study suggest that novel methods such as pCLE and WCE could be part of a mini-invasive algorithm for early detection of GI-GVHD.
Authors: H Glucksberg; R Storb; A Fefer; C D Buckner; P E Neiman; R A Clift; K G Lerner; E D Thomas Journal: Transplantation Date: 1974-10 Impact factor: 4.939
Authors: Khalid Khan; Sarah Jane Schwarzenberg; Harvey Sharp; Jose Jessurun; H Evin Gulbahce; Todd Defor; Rajaram Nagarajan Journal: Gastrointest Endosc Date: 2006-09 Impact factor: 9.427
Authors: M B Wallace; A Meining; M I Canto; P Fockens; S Miehlke; T Roesch; C J Lightdale; H Pohl; D Carr-Locke; M Löhr; E Coron; B Filoche; M Giovannini; J Moreau; C Schmidt; R Kiesslich Journal: Aliment Pharmacol Ther Date: 2009-11-30 Impact factor: 8.171
Authors: B Jones; E K Fishman; S S Kramer; S S Siegelman; R Saral; W E Beschorner; A M Yeager; A M Lake; R H Yolken; P Tutschka Journal: AJR Am J Roentgenol Date: 1986-04 Impact factor: 3.959