Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft‐versus‐host disease

Abstract

Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft‐versus‐host disease (GI‐GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI‐GVHD (2000‐2013) after receiving hematopoietic stem cell transplantation. Sixty‐eight children with ninety‐one endoscopic occasions were enrolled. At the time of endoscopy, anti‐GI‐GVHD treatment was ongoing in 71% (65/91). In 20% (13/65) with ongoing treatment, no histopathological evidence of GI‐GVHD or another cause to justify anti‐GI‐GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re‐endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (p=0.007). Histopathological findings generating treatment changes were; GI‐GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). Normal histology was the only histopathological finding that was significantly more frequent in the unchanged treatment group versus the treatment change group (p=0.029). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI‐GVHD.