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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?
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.