Early detection of acute graft-versus-host disease by wireless capsule endoscopy and probe-based confocal laser endomicroscopy: results of a pilot study. Issue 3 (June 2014)

• Record Type: Journal Article
• Authors: Coron, Emmanuel; Laurent, Valerie; Malard, Florent; Le Rhun, Marc; Chevallier, Patrice; Guillaume, Thierry; Mosnier, Jean-François; Galmiche, Jean-Paul; Mohty, Mohamad
• Is Part Of: United European Gastroenterology journal. Volume 2:Issue 3(2014:Jun.)
• Page Start: 206
• Page End: 215
• Publication Date: 2014-06
• Subjects: Early diagnosis -- graft-versus-host disease -- novel imaging techniques -- probe-based confocal laser endomicroscopy -- wireless capsule endoscopy; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640614529283
• Languages: English
• ISSNs: 2050-6406

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.