ACCURACY OF CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF GASTROINTESTINAL GRAFT-VERSUS-HOST-DISEASE

Aims Graft-versus-host disease (GVHD) is a common complication of hematopoietic cell transplantation. It can involve the skin, lungs, liver and gastrointestinal (GI) tract. The small bowel is one of the principles targets in the GI tract. The capsule endoscopy (CE) is a safe procedure and can be a useful tool for a quicker diagnosis in GI GVHD. The aim of this study is to compare the accuracy of the CE in GVHD with the histopathological findings.

Methods This is a retrospective single-center study that included all the patients with GVHD who underwent CE between July 2015 and July 2019. All the patients had EGD and colonoscopy with biopsies (stomach, duodenum, terminal ileum, cecum, ascending, transverse, descending and rectosigmoid). The CE findings were analyzed and compared with the histopathological diagnosis as the gold standard.

Results There were included 21 patients [7 (33%) female; 37 (±11.9) years old] with GVHD, 20 (95%) of them were acute. The median gastric transit time was 55 minutes (20-113) and median small bowel transit time was 261 minutes (238-434). Complete visualization of the small bowel by CE was observed in 17 cases (80.95%). Histopathological and CE findings diagnose GVHD in 17 and 16 cases respectively. The agreement between histopathological and CE findings were identified in 18 cases (15 positive and 3 negative to GVHD). The Kappa coefficient was 0.57. The CE’s sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) were of 88%, 75%, 94% and 60%, respectively. There were no complications associated to CE.

Conclusions CE is a safe procedure for diagnosis of gastrointestinal GVDH with a high sensibility and PPV and a moderate concordance compared to histopathological findings.