Z Gastroenterol 2010; 48 - P034
DOI: 10.1055/s-0030-1263478

Is zoom-endoscopic subaqual mucosa evaluation able to replace biopsy in the diagnostics of acute tissue rejection in patients with small intestine transplantation?

T Kratt 1, D Stüker 1, L Minkley 2, W Steurer 1, R Ladurner 1, S Nadalin 1, M von Feilitzsch 1, M Küper 1, C Thiel 1, HG Lamprecht 2, F Fend 3, C Hann von Weyhern 3, K Schröppel 4, A Königsrainer 1
  • 1Universitätsklinikum Tübingen, Allgemeine, Viszeral- und Transplantations-Chirurgie, Tübingen, Germany
  • 2Universitätsklinikum Tübingen, Medizinische Klinik II, Tübingen, Germany
  • 3Institut für Pathologie der Universität Tübingen, Tübingen, Germany
  • 4Institut für Mikrobiologie der Universität Tübingen, Tübingen, Germany

Acute tissue rejection, infection and relapse of Crohn's disease are possible complications after small intestine transplantation. Questions:

1. Is zoom-endoscopic evaluation sufficient for the identification of tissue rejection?

2. Is the “optical biopsy“ able to replace time-consuming histological findings in emergency situations?

3. Is it possible to replace zoom-endoscopy via special zoom devices by subaqual tissue evaluation with standard devices?

4. Is it sufficient to inspect only the transplant stoma?

Methods: Prospective study on 6 patients after small intestine transplantation. Endoscopic surveillance from the 2. postoperative day up to 47 months. SASAKI score for evaluation of mucosal changes. 271 endoscopic examinations with 260 biopsies.

Results:

Ad 1+2: 217 examinations without evidence of rejection and 28 examinations with endoscopic findings of rejection, what were confirmed by histology with excellent correlation. In 5 cases a beginning mild rejection was not observable with endoscopy; 2 other cases showed a beginning inflammatory reaction in endoscopy (Norovirus/Clostr. difficile), initially described as rejection by pathological evaluation, but later confirmed as inflammation. Sensitivity for endoscopic vs. histological evaluation was 85% vs. 94% and specificity was 94% vs. 99%.

Ad 3: Subaqual examination with regular scopes is sufficient for the ascertainment of the SASAKI-score.

Ad 4: One case showed in a distance of 10cm to the stoma the image of a mild rejection and in a distance of 30–40cm a severe rejection (histologically confirmed). Apoptosis-rate only partially correlated with the grade of tissue rejection (defining rejection by the evidence of >6 apoptosis per HPF).

Conclusion: Endoscopic staging according to the SASAKI score provides a high sensitivity and a specificity, nearly comparable to histological findings.

The utilization of zoom-endoscopes is helpful but not obligatory necessary.

Examining only the transplant stoma is not sufficient.

Apoptosis-rate only partially correlates with the grade of tissue rejection; early histological signs of rejection are rather an increase of tissue eosinophilia and lymphocytic infiltrates.