P0416 - Diagnostic Yield of Upper and Lower Endoscopic Biopsies for Evaluation of Suspected Acute Gastrointestinal Graft-Versus-Host Disease

Sailaja Pisipati, MBBS, FRCS¹, Kevin Song, MD², Suaka Kagbo-Kue, MBBS¹, Jonathan A. Leighton, MD, FACG¹, Kevin C. Ruff, MD¹, Francisco C. Ramirez, MD, FACG^1
1Mayo Clinic, Scottsdale, AZ; ²Mayo Clinic College of Medicine, Scottsdale, AZ

Introduction: Acute graft-versus-host-disease (GVHD) is a common complication following hematopoietic stem cell transplant (HSCT) with gastrointestinal (GI) tract being the second most commonly involved site. Although GI symptoms are common, they are non-specific and can be caused by toxicity from chemoradiation, infections or medication side-effects. Hence, confirmatory biopsies are required to establish GI-GVHD. Thrombocytopenia and concerns for hemorrhage preclude extensive biopsies. Site of confirmatory biopsies has been a topic of debate with the conventional studies supporting rectosigmoid biopsies and later studies suggesting that gastroduodenal biopsies may provide additional information. We aimed to determine the diagnostic yield of endoscopically obtained mucosal biopsies from different GI sites in patients with suspected GI-GVHD.

Methods: All encounters for bidirectional endoscopic biopsies performed between Oct 2011 and Nov 2020, on patients who were post HSCT, for evaluation of suspected GI-GVHD were identified. Basic demographic, endoscopic and pathological information was collected retrospectively. Gastric, duodenal, rectal and sigmoid colonic biopsies were obtained using a standard protocol. Lerner grading system was used to grade the severity of GI-GVHD.

Results: Of a total of 450 encounters identified during the study period, data was complete for bidirectional endoscopic evaluation in 409. Mean age of our study cohort was 54.3 years, with 54.5% (n=223) being men. 77.3% (n=316) of these encounters were positive for GI-GVHD. The diagnostic yield of gastric and duodenal biopsies was 61.7 (n=195) and 73.7% (n=233) respectively. Diagnostic yield of rectal and sigmoid biopsies was 84.8% (n=268) and 79.1% (n=250) respectively. The overall yield of combined rectosigmoid biopsies was higher (90.2%) than combined gastroduodenal biopsies (81.3%).

Discussion: Over three-fourths of bidirectional endoscopic encounters performed for evaluation of suspected GVHD in post HSCT patients were positive for a diagnosis of GI-GVHD. The diagnostic yield of rectosigmoid biopsies was slightly higher than gastroduodenal biopsies. Obtaining rectosigmoid biopsies alone, would have not resulted in a change of management in 92% of our cohort. Further correlation of these pathologic findings to endoscopic appearances and clinical symptoms is required to enhance our understanding and target biopsies to specific sites that pose a high diagnostic yield.

Diagnostic Yield of Site Specific Biopsies		N	%
Gastric		195	61.7
Duodenal		233	73.7
Rectal		268	84.8
Sigmoid colon		250	79.1
Diagnostic Yield of Lower and Upper GI Biopsies
Rectosigmoid	Gastroduodenal	N	%
No	No	93	22.7
Yes	Yes	226	55.3
Yes	No	59	14.4
No	Yes	31	7.6

Table: Table 1 : Diagnostic Yield of Upper and Lower GI biopsies


Disclosures:
Sailaja Pisipati indicated no relevant financial relationships.
Kevin Song indicated no relevant financial relationships.
Suaka Kagbo-Kue indicated no relevant financial relationships.
Jonathan Leighton indicated no relevant financial relationships.
Kevin Ruff indicated no relevant financial relationships.
Francisco Ramirez indicated no relevant financial relationships.


Sailaja Pisipati, MBBS, FRCS¹, Kevin Song, MD², Suaka Kagbo-Kue, MBBS¹, Jonathan A. Leighton, MD, FACG¹, Kevin C. Ruff, MD¹, Francisco C. Ramirez, MD, FACG¹. P0416 - Diagnostic Yield of Upper and Lower Endoscopic Biopsies for Evaluation of Suspected Acute Gastrointestinal Graft-Versus-Host Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.