Y Jiao, Y Zhao, Z Chen, L Yang, Q Fu, Z Wang, F Tao, Y Du, M Sun, W Lu, S Qi, H Xiong

Abstract

Objective: This study investigated the role of gastrointestinal (GI) endoscopy in diagnosing acute GI graft-versus-host disease (GVHD) in paediatric patients following allogeneic haematopoietic stem cell transplantation (allo-HSCT). Methods: We clinically analysed 35 paediatric patients suspected of having GI-GVHD after allo-HSCT who underwent gastrointestinal endoscopy between January 2019 and December 2023. We evaluated their endoscopic findings, biopsy histopathological diagnoses, and their implications for clinical management. Results: During the study period, 73 out of 256 patients who underwent allo-HSCT developed GI symptoms, and 35 (14%) patients required GI endoscopy. The primary endoscopic manifestations in this study included mucosal congestion, oedema, erosion, ulceration, exfoliation, and active bleeding. Tissue biopsy histopathology was not performed in seven patients, and four (14%) showed no significant histologic abnormalities. GI-GVHD was diagnosed histologically in 24 patients (86%), of whom four had GI-GVHD with cytomegalovirus (CMV) enterocolitis, one had GI-GVHD with Epstein-Barr virus (EBV) enterocolitis, and 15 had GI-GVHD with transplant-associated thrombotic microangiopathy (TA-TMA). Seventeen patients were started on anti-GI-GVHD treatment according to clinical criteria before endoscopy, and the diagnosis of clinical GI-GVHD was confirmed by biopsy in 15 patients. Conclusions: In our experience, endoscopic diagnosis of GI-GVHD in paediatric patients is both feasible and safe. Patients with clinically suspected intestinal GVHD should undergo timely and complete GI endoscopy for a definitive diagnosis.