Endoscopy 2020; 52(S 01): S224-S225
DOI: 10.1055/s-0040-1704701
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 11:30 – 12:00 Rare diseases 2 ePoster Podium 8
© Georg Thieme Verlag KG Stuttgart · New York

A PROSPECTIVE EVALUATION OF THE GOTHENBURG INTESTINAL TRANSPLANT ENDOSCOPY SCORE

J Varkey
1   University of Gothenburg, Internal Medicine, Gothenburg, Sweden
,
S Yamamoto
1   University of Gothenburg, Internal Medicine, Gothenburg, Sweden
,
G Herlenius
2   University of Gothenburg, Transplant Institute, Gothenburg, Sweden
,
R Sadik
1   University of Gothenburg, Internal Medicine, Gothenburg, Sweden
,
M Oltean
2   University of Gothenburg, Transplant Institute, Gothenburg, Sweden
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Intestinal transplantation is a procedure aimed to reverse the life-threatening complications seen in patients with intestinal failure. However, the major factor that influences long-term survival and hinders a firm establishment of this procedure is the occurrence of rejection. Nevertheless, a grading system for its severity is still lacking. Therefore Gothenburg Intestinal Transplant Endoscopy Score (GITES) was developed by our team. GITES is a novel, five-stage score aiming to describe and categorize the endoscopic findings after intestinal transplantation. In theory, this system could result in a more objective evaluation of the visual findings and subsequently a faster diagnosis of rejection.

Methods We prospectively graded the endoscopic findings with GITES in 13 adult patients at one single center using white light high-definition endoscopy systems. The scoring was performed by the endoscopist at the time of endoscopy and later we correlated the results with histology.

Results Eighty-five ileoscopies were performed between January 2015 to February 2019. In 52 (61%) cases the endoscopic findings were normal. Twenty-three (69%) out of the 33 abnormal endoscopies revealed mild alterations represented by mild/moderate edema, erythema or blunted villi (GITES 1 and 2). Rejection was found in biopsies from 11 (14%) endoscopy sessions (4 mild & 7 moderate/severe) and in three specimens the biopsies revealed CMV enteritis. GITES above 1 (erythema, edematous villi) had 91% sensitivity and 94% specificity for rejection whereas positive (PPV) and negative predictive values (NPVs) were 78% and 98%, respectively. During moderate and severe rejection, GITES revealed 87% sensitivity and 94% specificity whereas positive (PPV) and negative predictive values (NPVs) were 78% and 98% respectively.

Conclusions These results suggest that evaluation of the endoscopic findings with GITES results in a satisfactory identification and stratification of rejection. A prospective, multicenter evaluation is needed.