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EFFICACY OF CAPSULE ENDOSCOPY ADDED TO COLONOSCOPY IN THE DIAGNOSIS OF CYTOMEGALOVIRUS COLITIS FOR PATIENTS WITH ALLOGENIC STEM CELL TRANSPLANTATION

Mitsunobu Saito 1, Hiroyuki Takamaru 1, Izumi Hisada 1, Keiko Nakamura 1, Yasuo Kakugawa 1, Takashi Tanaka 1, Takahiro Fukuda 1, Yutaka Saito 1

Affiliations

1 National Cancer Center Hospital, Tokyo, Japan

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Abstract

Introduction

Graft-versus-host disease (GVHD) in the lower gastrointestinal tract and cytomegalovirus (CMV) colitis frequently occur as adverse events after allogeneic bone marrow transplantation. GVHD in the lower gastrointestinal tract is treated with prednisolone (PSL), while it aggravates CMV colitis. Therefore, a differential diagnosis between GVHD in the lower gastrointestinal tract and CMV colitis is essential to determine the treatment strategy.
CMV colitis is histologically diagnosed by biopsy during colonoscopy (CS), however, it takes 1-2 weeks to confirm the diagnosis. Therefore, it is key to diagnose based on endoscopic findings starting treatment promptly for patients with suspected CMV colitis after allogeneic bone marrow transplantation. It is also mandatory to accurately diagnose CMV colitis at an early stage because CMV colitis is known to be challenging to control and has a poor prognosis when complicated with GVHD in the lower gastrointestinal tract.
We have previously reported that ulceration and erosion are independent factors that can predict CMV colitis in colonoscopy. We hypothesized that CMV colitis could be predicted by findings of ulceration and/or erosion in small intestine capsule endoscopy (CE).

Aims & Methods

In this study, we investigated whether the findings of ulceration and/or erosion in capsule endoscopy have an additive effect on colonoscopy in the diagnosis of CMV colitis.
A total of seventy-five patients who underwent both CS and CE from 2007 to 2020 were included among 271 patients with suspected lower gastrointestinal GVHD based on their clinical course. All colonoscopy images were reviewed by one expert. Capsule endoscopic findings were obtained from reporting system. Each examination was evaluated for the presence of ulcerations and erosions. CMV colitis was defined as histopathologic evidence of at least one CMV infected cell in the biopsy specimens of the colon mucosa. “Colonoscopy diagnosed CMV” was defined when the ulceration or erosion was observed by CS. “CE diagnosed CMV” was defined when the ulceration or erosion was observed by CE or CS, that showed an additional effect of CE examination on CS examination for diagnosis performance of CMV.
The diagnostic performance of “Colonoscopy diagnosed CMV” and “CE diagnosed CMV” were investigated.

Results

The median age of the patients was 55 years (range 16-69), and the male was 50 and the female was 25. Thirty-six patients had GVHD alone, 4 patients had CMV alone, and 26 patients had both GVHD and CMV. Therefore, 30 patients were pathologically CMV-positive.
Of the 30 patients with CMV colitis, 14 showed ulceration or erosion on CS. The sensitivity and specificity of “Colonoscopy diagnosed CMV” were 46.7% and 71.1%, respectively.
Of 30 patients with CMV colitis, 19 patients had ulceration or erosion in “CE diagnosed CMV“. The sensitivity and specificity of CMV enteritis with “CE diagnosed CMV” were 63.3% and 48.9%, respectively.

Conclusion

When CE was performed in patients with suspected post-transplant GVHD or CMV enteritis and positive findings of ulceration or erosion were used to diagnose CMV colitis, the sensitivity to diagnose CMV colitis with CE additional to CS was 16.6% higher than that with CS alone. The results suggest that CE may be useful in decreasing the overlooked CMV colitis.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

Lower GI endoscopy interventions (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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