Stepwise Endoscopy Based on Sigmoidoscopy in Evaluating Pediatric Graft-versus-Host Disease

Area of Science:

• Pediatric Gastroenterology
• Hematology and Oncology
• Transplant Medicine

Background:

• Gastrointestinal (GI) graft-versus-host disease (GVHD) is a serious complication after stem cell transplantation.
• Accurate and timely diagnosis of GI GVHD in children is crucial for effective management.
• Current diagnostic methods for pediatric GI GVHD require evaluation for sensitivity and negative predictive values.

Purpose of the Study:

• To establish a safe and convenient diagnostic method for acute GI GVHD in children.
• To determine the sensitivity and negative predictive values of upper and lower endoscopic biopsies for diagnosing pediatric GI GVHD.

Main Methods:

• Retrospective study of pediatric patients suspected of GI GVHD.
• Inclusion criteria: endoscopic evaluation within 100 days post-stem cell transplantation.
• Analysis of endoscopic biopsy sensitivity and negative predictive values from esophagus, stomach, duodenum, and lower endoscopy.

Main Results:

• Fifteen pediatric patients (20 endoscopic procedures) were analyzed.
• Lower endoscopic biopsy demonstrated higher overall sensitivity (88.9%) and negative predictive value (66.7%) for GI GVHD compared to upper endoscopy (77.8% and 50.0%, respectively).
• Duodenal biopsy sensitivity was 80.0% with a negative predictive value of 60.0%.

Conclusions:

• Flexible sigmoidoscopy is recommended as a safe and accurate diagnostic tool for pediatric GI GVHD.
• If sigmoidoscopy is negative despite high suspicion of GI bleeding, full colonoscopy and upper endoscopy should be considered.
• Endoscopic biopsies play a key role in diagnosing GI GVHD in pediatric stem cell transplant recipients.