Sensitivities of Biopsy Sites in the Endoscopic Evaluation of Graft-Versus-Host Disease: Retrospective Review from a Tertiary Center.

BACKGROUND: Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation that frequently affects the gastrointestinal (GI) tract. The best biopsy sites to establish the diagnosis have not been clearly established.

AIMS: To determine the best sites for obtaining biopsies in evaluating GI GVHD.

METHODS: All cases of biopsy-proven GI GVHD (GVHD+) were isolated from a pathology database over a 2-year period at a single tertiary center (n = 46). Demographic, clinical, and endoscopic data were extracted. For comparison, 46 consecutive GVHD-negative cases (GVHD-) were obtained. Sensitivities in diagnosing GVHD in the upper and lower GI tract were calculated.

RESULTS: In the GVHD- group, they were commonly investigated with an esophagogastroduodenoscopy (EGD) (60 vs. 22 % in the GVHD+ group, p < 0.01), while a colonoscopy (CLN) was commonly performed in the GVHD+ group (33 vs. 12 %, p = 0.02). Among the GVHD + patients, for EGDs, the sensitivity was highest for duodenal biopsies at 89 %. For flexible sigmoidoscopies (FSs) and CLNs, the sensitivities among all sites were similar (85 % agreement, kappa 0.58, p = 0.01). There were no cases in which GVHD was diagnosed in the right side of the colon without a positive biopsy in the left side of the colon.

CONCLUSIONS: In this cohort of GI GVHD patients, duodenum biopsies produced the highest yield in diagnosing GVHD when compared to other sites of the upper GI tract. Sensitivities were similar among all sites on lower endoscopies, suggesting that a FS is sufficient for diagnosing GVHD in suspected patients with diarrhea.