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. 2021 Jul 1;34(3):125-129.

Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease

[Article in English, Spanish]
I Diéguez  1 , R Fonseca  1 , J Cortés  1 , I Miró  1 , A Costa  1 , M Del Peral  1 , J J Vila  1
Affiliations
  • PMID: 34254749
Free article

Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease

[Article in English, Spanish]
I Diéguez et al. Cir Pediatr. .
Free article

Abstract
in English, Spanish

Introduction: Graft-versus-host disease (GVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with high morbidity and mortality rates. Intestinal clinical signs are unspecific, which means differential diagnosis with infections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standard technique, there is no consensus as to which sampling method is best.

Objective: To assess the results of the biopsy techniques used in patients with suspected intestinal GVHD.

Material and methods: A retrospective study of patients with suspected intestinal GVHD undergoing allo-HSCT from 2010 to 2019 was carried out. They were assessed through digestive biopsy - esophagogastroduodenal biopsy (upper GI endoscopy - UGIE) or rectal biopsy (colonoscopy or direct biopsy). Quantitative variables, expressed as median and interquartile range, and qualitative variables, expressed as absolute frequency and percentage, were collected.

Results: 23 patients were studied, 60.9% of whom were male. Median age at biopsy was 9 years (7-14 years). UGIE was used in 47.8% of patients (n=11), colonoscopy was used in 26.1% of patients (n=6), and direct biopsy was used in 34.8% of patients (n=8), with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%) patients, respectively.

Conclusions: Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.

Introduccion: La enfermedad injerto contra huésped (EICH) es una complicación frecuente de los trasplantes de células precursoras hematopoyéticas alogénicos (alo-TCPH), con gran morbimortalidad. La clínica intestinal es inespecífica, planteando el diagnóstico diferencial con infecciones y etiología medicamentosa. Aunque las biopsias intestinales son el gold standard, no existe consenso sobre la mejor técnica para obtenerlas.

Objetivo: Evaluar los resultados de las técnicas empleadas para obtener biopsias en pacientes con sospecha de EICH intestinal.

Material y metodos: Estudio retrospectivo que incluye pacientes sometidos a alo-TCPH entre 2010 y 2019, con sospecha de EICH intestinal estudiados mediante biopsias digestivas: esofagogastroduodenales (endoscopia digestiva alta - EDA) o rectales (colonoscopia o biopsia directa). Recogimos variables cuantitativas, expresadas como mediana y rango intercuartílico; y cualitativas, expresadas en frecuencia absoluta y porcentaje.

Resultados: Estudiamos 23 pacientes (60,9% varones). La mediana de edad en el momento de la biopsia fue 9 años (7-14 años). Empleamos EDA en el 47,8% (n= 11), colonoscopia en 26,1% (n= 6) y biopsia directa en el 34,8% (n= 8); siendo positivas para EICH en 2 (18,2%), 2 (33,3%) y 4 (50%), respectivamente.

Conclusiones: Las muestras obtenidas mediante biopsia directa se plantean como una alternativa eficiente en el diagnóstico del EICH.

Keywords: Bone marrow transplantation; Colonoscopy; GVHD; Graft-versus-host disease; Rectal biopsy.

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