Endoscopy Following Pediatric Intestinal Transplant.
Endoscopy Following Pediatric Intestinal Transplant.
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DOI：
10.1097/mpg.0000000000000871
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发表时间：
2015-12
影响因子：
2.9
通讯作者：
Venick RS
中科院分区：
文献类型：
--
作者：
Yeh J;Ngo KD;Wozniak LJ;Vargas JH;Marcus EA;McDiarmid SV;Farmer DG;Venick RS
活检仍然是诊断肠移植（ITx）排斥反应的金标准，胃肠道内窥镜检查在患者管理中起着关键作用。在此，我们描述了一个单中心23年的内镜下儿科ITx接受者的经验。对1991年至2013年期间所有<18岁的ITx接受者的内窥镜检查和病理学报告进行了回顾性审查，旨在描述手术适应症、结果和并发症。在1014次治疗中共进行了1770例内镜手术。EGD和回肠镜联合是最常见的手术（36%）。粪便排出量增加（35%）和监测内镜检查（32%）是最常见的适应症。诊断出162例活检证实的排斥反应。首次排斥反应发生在ITx后1个月（中位数）。45%的组织学证实的排斥反应具有正常的内窥镜外观。手术并发症（包括但不限于出血和穿孔）的发生率为1.8%。内镜活检在ITx接受者的护理中起着重要作用。移植物监测、排斥诊断、后续治疗和治疗随访需要多种程序。大体内镜表现，特别是在轻度至中度急性细胞排斥反应中，与组织学没有很好的相关性。复杂的解剖结构、高于非ITx儿科内镜病例的并发症发生率以及由经验丰富的病理学家进行的及时组织学解释是这些手术应在习惯于照顾ITx接受者的中心进行的原因。该领域将受益于非侵入性生物标志物的发展，以可靠和有效地检测排斥反应。
Biopsies remain the gold standard in the diagnosis of intestinal transplant (ITx) rejection, and gastrointestinal endoscopy plays a pivotal role in patient management. Herein, we describe a single center 23 year endoscopic experience in pediatric ITx recipients. A retrospective review of endoscopy and pathology reports of all ITx recipients <18 years old transplanted between 1991 and 2013 was performed with the aim of describing the procedural indications, findings, and complications. A total of 1770 endoscopic procedures within 1014 sessions were performed. Combination EGD and ileoscopy was the most common procedure (36%). Increased stool output (35%) and surveillance endoscopy (32%) were the most common indications. 162 episodes of biopsy proven rejection were diagnosed. First episode of rejection occurred at a median of 1 month post-ITx. 45% of histology-proven rejection had normal appearing endoscopies. The rate of procedural complications including but not limited to bleeding and perforation was 1.8%. Endoscopy with biopsy plays a significant role in the care of ITx recipients. Multiple procedures are required for graft surveillance, diagnosis of rejection, subsequent treatment, and follow-up of therapy. The gross endoscopic appearance, particularly in mild to moderate acute cellular rejection, does not correlate well with histology. Complex anatomy, complication rates which are higher than non-ITx pediatric endoscopy cases, and timely histologic interpretation by experienced pathologists are reasons that these procedures should be performed at centers accustomed to caring for ITx recipients. The field would benefit from the development of a noninvasive biomarker to reliably and efficiently detect rejection.