Endoscopic presentation of gastrointestinal graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.issn.1007-5232.2013.10.002
- VernacularTitle:造血干细胞移植后肠道移植物抗宿主病的内镜表现
- Author:
Jinde HE
;
Kunkun SUN
;
Guodong CHEN
;
Jingbo WANG
;
Xiaohui ZHANG
;
Yulan LIU
- Publication Type:Journal Article
- Keywords:
Peripheral blood stem cell transplantation;
Graft-versus-host disease;
Colonoscopy
- From:
Chinese Journal of Digestive Endoscopy
2013;30(10):550-554
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate colonoscopic presentation and explore biopsy style of lower gastrointestinal graft-versus-host disease (GI-GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The endoscopic findings including mucosa erythema,edema,erosion,ulcer,tortoiseshell-pattern and sloughing were observed in 36 patients with GI-GVHD and the rate of apoptotic cell yields in colon and end-ileum was calculated.Results Mucosa lesions were found in almost all of the patients both in colorectal and end-ileum (97.2％ vs 94.1％,P =0.609).Mucosa erythema was more often seen in end-ileum (47.2％ vs 79.4％,P =0.007) and tortoiseshell-pattern was mainly in colorectal mucosa (63.9％ vs 5.9％,P =0.000).Mucosa edema,erosion and oozing bleeding were the same prevalence in large intestine and end-ileum (97.2％ vs 94.1％,80.6％ vs 79.4％,47.2％ vs 47.1％,P ＞ 0.05,respectively).Sloughing was found in 76.5％ (26/34) GI-GVHD patients,and it was almost the same prevalence in large intestine and end-ileum (52.8％ vs 47.1％,P ＞0.05).Almost all of the colorectal mucosa sloughing located in the tortoiseshell-pattern mucosa.Rates of apoptotic cell in rectal,colonic and end-ileal mucosa were 88.9％,91.3％ and 75.9％,respectively,and the rates were 88.2％ and 93.9％ in ileum plus rectum and ileum plus colon respectively,showing that biopsy only in ileum was not sufficient for the pathologic diagnosis of GI-GVHD (93.9％ vs 75.9％,P =0.070).Conclusion Endoscopic presentations of GI-GVHD after allo-HSCT are not the same between colorectal and end-ileal mucosa.Sloughing with GIGVHD feature is not rarely seen in lower GI.Tortoiseshell-pattern mucosa should also be pathognomonic feature of colorectal GVHD in endoscopy.Pathologic tissue should not only be biopsied in end-ileum,but also in colorectal mucosa in the same time.
