Capsule Endoscopy In Intestinal Graft-Versus-Host Disease

Graft-Versus-Host Disease The small intestine is the most common location of intestinal GVHD. EGD with duodenal biopsy yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) offers complete evaluation of the small intestine. To compare the diagnostic value of EGD with biopsy with the results of WCE in patients with acute intestinal symptoms who received allogenic blood stem cell transplantation and to analyze the appearance and distribution of acute intestinal GVHD lesions in these patients, an investigative-blinded, single-center prospective study was carried out. Clinical data were recorded during two months of follow-up with performance of the procedures within 24 hours of symptoms. Fourteen consecutive patients were recruited with these symptoms. In one patient the capsule remained in the stomach and was removed endoscopically. In seven of thirteen patients evaluated, acute intestinal GVHD was diagnosed by EGD with biopsies but three of these would have been missed by EGD alone. In all seven patients with histologically confirmed acute intestinal GVHD, WCE revealed typical signs of GVHD. Lesions were scattered throughout the small intestine but were most accentuated in the ileum. In this study with a small number of patients, WCE showed a comparable sensitivity and high-negative predictive value with diagnosing acute intestinal GVHD and compared with EGD with biopsies. It may be helpful to avoid repeat endoscopic procedures in patients who have undergone stem cell transplantation. (Neumann S, Schoppmeyer K, Lang ET, et al. “Wireless Capsule Endoscopy for Diagnosis of Acute Intestinal Graft-Versus-Host Disease.” Gastrointest Endosc, 2007; 65:403-409.)