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Published in:

01-05-2006

Zoom endoscopic monitoring of small bowel allograft rejection

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

Published in: Surgical Endoscopy | Issue 5/2006

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.

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Title: Zoom endoscopic monitoring of small bowel allograft rejection
Authors: T. Kato
J. J. Gaynor
S. Nishida
N. Mittal
G. Selvaggi
D. Levi
J. Moon
J. Thompson
P. Ruiz
J. Madariaga
A. G. Tzakis
Publication date: 01-05-2006
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2006
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-005-0331-2

At a glance: The STEP trials

Springer Medicine

Zoom endoscopic monitoring of small bowel allograft rejection

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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