Diagnostic endoscopy in children after hematopoietic stem cell transplantation

Area of Science:

• Pediatric Gastroenterology
• Hematology
• Transplantation Medicine

Background:

• Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric hematologic and oncologic diseases.
• Gastrointestinal (GI) complications, including acute graft-versus-host disease (GVHD), are significant concerns post-HSCT.
• Endoscopic evaluation is often necessary to diagnose and manage these GI issues.

Purpose of the Study:

• To evaluate the diagnostic yield of endoscopic procedures in children following HSCT.
• To assess the complication rates associated with endoscopy in this vulnerable patient population.
• To correlate findings with the timing of HSCT and patient characteristics.

Main Methods:

• Retrospective review of data from 191 pediatric patients undergoing HSCT.
• Procedures were categorized based on timing: within the first 100 days post-HSCT and beyond 100 days.
• Analysis included diagnostic findings from esophagogastroduodenoscopies (EGDs) and sigmoidoscopies, including biopsy results for GVHD and other histologies.

Main Results:

• Endoscopic lesions were identified in 32% of EGDs and 16% of sigmoidoscopies.
• Acute GVHD was diagnosed in 31% of EGD biopsies and 38% of sigmoidoscopy biopsies within 100 days post-HSCT.
• Overall complication rate was 3.1%, with intestinal bleeding in 12 procedures, significantly associated with thrombocytopenia.

Conclusions:

• Endoscopy provides valuable diagnostic information for GI abnormalities in children post-HSCT, beyond acute GVHD.
• Acute GVHD is frequently diagnosed via sigmoid biopsies.
• Post-procedure hemorrhage is a notable complication, particularly in patients with thrombocytopenia, highlighting the need for careful patient selection and monitoring.