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Zoom endoscopic monitoring of small bowel allograft rejection

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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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Acknowledgments

This work was supported in part by grant no. DK061445 from the National Institutes of Health, and by an educational grant from Fujisawa Healthcare. In addition, the zoom endoscopic equipment used during the first period of the study was supplied free of charge by Pentax Precision Instruments, Inc.

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Authors and Affiliations

  1. Department of Surgery, University of Miami, School of Medicine, 1801 NW 9th Avenue, 5th Floor, Miami, FL, 33136, USA

    T. Kato, J. J. Gaynor, S. Nishida, G. Selvaggi, D. Levi, J. Moon, J. Madariaga & A. G. Tzakis

  2. Department of Pediatrics, University of Miami, School of Medicine, Miami, FL, 33136, USA

    N. Mittal & J. Thompson

  3. Department of Pathology, University of Miami, School of Medicine, Miami, FL, 33136, USA

    P. Ruiz

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  1. T. Kato
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  2. J. J. Gaynor
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  5. G. Selvaggi
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  8. J. Thompson
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  9. P. Ruiz
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  10. J. Madariaga
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  11. A. G. Tzakis
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Corresponding author

Correspondence to T. Kato.

Additional information

Part of this work was presented during the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 29 March to 1 April 2000, Atlanta, GA.

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Kato, T., Gaynor, J.J., Nishida, S. et al. Zoom endoscopic monitoring of small bowel allograft rejection. Surg Endosc 20, 773–782 (2006). https://doi.org/10.1007/s00464-005-0331-2

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  • DOI: https://doi.org/10.1007/s00464-005-0331-2

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