Zoom endoscopic monitoring of small bowel allograft rejection

T. Kato, J. J. Gaynor, S. Nishida, Naveen K Mittal, G. Selvaggi, D. Levi, J. Moon, J. Thompson, P. Ruiz, J. Madariaga, A. G. Tzakis

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: The small bowel has been successfully transplanted in patients with irreversible intestinal failure. This report aims to describe endoscopic monitoring of small bowel rejection. Methods: A magnification endoscope (zoom endoscope) was used in this study. In the first part of the study (October 1998 to March 2000, 271 endoscopy sessions), the specific endoscopic findings that correlated with rejection were determined. An analysis then was performed on data from the second period (March 2001 to November 2002, 499 sessions) to evaluate the zoom endoscope's accuracy in monitoring rejection. Results: Specific endoscopic findings of rejection found in the first period included background erythema, villous congestion, blunted villous tip, and shortened villous height. When the rejection was successfully treated, endoscopic appearance returned to normal. On the basis of these findings, five endoscopic criteria (villous shortening, villous blunting, background erythema, villous congestion, and mucosal friability) were used to score endoscopic sessions in the second period. Endoscopic diagnosis of rejection was compared with histology. Adult patients showed a sensitivity of 45%, a specificity of 98%, a positive predictive value of 82%, and a negative predictive value of 88%. In pediatric patients, these values were, respectively, 61%, 84%, 57%, and 86%. On 59 distinct occasions (30 in period 1 and 29 in period 2) in which the results were endoscopy negative yet biopsy positive (mild) for rejection, we elected not to treat these rejections on the basis of clinical evaluation, and 58 (98%) resolved without further therapy. Conclusions: With the use of magnification, endoscopy is a useful tool for monitoring acute rejection in the small bowel allograft.

Original languageEnglish (US)
Pages (from-to)773-782
Number of pages10
JournalSurgical Endoscopy and Other Interventional Techniques
Volume20
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

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Endoscopes
Endoscopy
Allografts
Erythema
Histology
Pediatrics
Biopsy
Therapeutics

Keywords

  • Small bowel allograft rejection
  • Small bowel transplantation
  • Zoom endoscopic monitoring

ASJC Scopus subject areas

  • Surgery

Cite this

Kato, T., Gaynor, J. J., Nishida, S., Mittal, N. K., Selvaggi, G., Levi, D., ... Tzakis, A. G. (2006). Zoom endoscopic monitoring of small bowel allograft rejection. Surgical Endoscopy and Other Interventional Techniques, 20(5), 773-782. https://doi.org/10.1007/s00464-005-0331-2

Zoom endoscopic monitoring of small bowel allograft rejection. / Kato, T.; Gaynor, J. J.; Nishida, S.; Mittal, Naveen K; Selvaggi, G.; Levi, D.; Moon, J.; Thompson, J.; Ruiz, P.; Madariaga, J.; Tzakis, A. G.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 5, 05.2006, p. 773-782.

Research output: Contribution to journalArticle

Kato, T, Gaynor, JJ, Nishida, S, Mittal, NK, Selvaggi, G, Levi, D, Moon, J, Thompson, J, Ruiz, P, Madariaga, J & Tzakis, AG 2006, 'Zoom endoscopic monitoring of small bowel allograft rejection', Surgical Endoscopy and Other Interventional Techniques, vol. 20, no. 5, pp. 773-782. https://doi.org/10.1007/s00464-005-0331-2
Kato, T. ; Gaynor, J. J. ; Nishida, S. ; Mittal, Naveen K ; Selvaggi, G. ; Levi, D. ; Moon, J. ; Thompson, J. ; Ruiz, P. ; Madariaga, J. ; Tzakis, A. G. / Zoom endoscopic monitoring of small bowel allograft rejection. In: Surgical Endoscopy and Other Interventional Techniques. 2006 ; Vol. 20, No. 5. pp. 773-782.
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AU - Kato, T.

AU - Gaynor, J. J.

AU - Nishida, S.

AU - Mittal, Naveen K

AU - Selvaggi, G.

AU - Levi, D.

AU - Moon, J.

AU - Thompson, J.

AU - Ruiz, P.

AU - Madariaga, J.

AU - Tzakis, A. G.

PY - 2006/5

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N2 - Background: The small bowel has been successfully transplanted in patients with irreversible intestinal failure. This report aims to describe endoscopic monitoring of small bowel rejection. Methods: A magnification endoscope (zoom endoscope) was used in this study. In the first part of the study (October 1998 to March 2000, 271 endoscopy sessions), the specific endoscopic findings that correlated with rejection were determined. An analysis then was performed on data from the second period (March 2001 to November 2002, 499 sessions) to evaluate the zoom endoscope's accuracy in monitoring rejection. Results: Specific endoscopic findings of rejection found in the first period included background erythema, villous congestion, blunted villous tip, and shortened villous height. When the rejection was successfully treated, endoscopic appearance returned to normal. On the basis of these findings, five endoscopic criteria (villous shortening, villous blunting, background erythema, villous congestion, and mucosal friability) were used to score endoscopic sessions in the second period. Endoscopic diagnosis of rejection was compared with histology. Adult patients showed a sensitivity of 45%, a specificity of 98%, a positive predictive value of 82%, and a negative predictive value of 88%. In pediatric patients, these values were, respectively, 61%, 84%, 57%, and 86%. On 59 distinct occasions (30 in period 1 and 29 in period 2) in which the results were endoscopy negative yet biopsy positive (mild) for rejection, we elected not to treat these rejections on the basis of clinical evaluation, and 58 (98%) resolved without further therapy. Conclusions: With the use of magnification, endoscopy is a useful tool for monitoring acute rejection in the small bowel allograft.

AB - Background: The small bowel has been successfully transplanted in patients with irreversible intestinal failure. This report aims to describe endoscopic monitoring of small bowel rejection. Methods: A magnification endoscope (zoom endoscope) was used in this study. In the first part of the study (October 1998 to March 2000, 271 endoscopy sessions), the specific endoscopic findings that correlated with rejection were determined. An analysis then was performed on data from the second period (March 2001 to November 2002, 499 sessions) to evaluate the zoom endoscope's accuracy in monitoring rejection. Results: Specific endoscopic findings of rejection found in the first period included background erythema, villous congestion, blunted villous tip, and shortened villous height. When the rejection was successfully treated, endoscopic appearance returned to normal. On the basis of these findings, five endoscopic criteria (villous shortening, villous blunting, background erythema, villous congestion, and mucosal friability) were used to score endoscopic sessions in the second period. Endoscopic diagnosis of rejection was compared with histology. Adult patients showed a sensitivity of 45%, a specificity of 98%, a positive predictive value of 82%, and a negative predictive value of 88%. In pediatric patients, these values were, respectively, 61%, 84%, 57%, and 86%. On 59 distinct occasions (30 in period 1 and 29 in period 2) in which the results were endoscopy negative yet biopsy positive (mild) for rejection, we elected not to treat these rejections on the basis of clinical evaluation, and 58 (98%) resolved without further therapy. Conclusions: With the use of magnification, endoscopy is a useful tool for monitoring acute rejection in the small bowel allograft.

KW - Small bowel allograft rejection

KW - Small bowel transplantation

KW - Zoom endoscopic monitoring

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