O17 Clinical utility and complications of diagnostic flexible gastro-intestinal endoscopy in patients post allogeneic haematopoetic stem cell transplant: 11 year experience from a single centre

• Published in: Frontline gastroenterology 2022-04, Vol.13 (Suppl 1), p.A13-A13
• Main Authors: Chan, Joe, Ganosi, Vasilliki, Basude, Dharam, Mirci-Danicar, Oana, Wiskin, Anthony
• Format: Article
• Language: English
• Subjects: Endoscopy; Graft versus host disease; Histology; Patients; Stem cell transplantation; Steroids; Wednesday 26th April 2022
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2022-bspghan.17

BackgroundDiagnostic flexible gastro-intestinal endoscopy can be used post Allogeneic Haematopoetic Stem Cell Transplant (Allo-HSTC) to guide clinical management. It is increasingly used to try and differentiate Gastro-intestinal Graft versus Host Disease (GI-GvHD), which requires escalation of immunosuppressive treatment (IST), from viral infection in particular which requires reduction of IST.AimsThis service evaluation, in our centre, aimed to establish: i) complication rate of diagnostic gastro-intestinal flexible endoscopy in children post Allo-HSTC ii) clinical utility of endoscopy post Allo-HSTC.MethodsPatients were identified from endoscopy records and Paediatric HSTC database between January 2010 and December 2020. Medical records and results were reviewed and data collected directly into an excel spreadsheet by the authors working in pairs. Authors made a decision on whether the endoscopy had been of clinical benefit if either; resulted in a change of management; or confirmed clinical decision, for example confirming GI-GvHD more likely than infection.ResultsA total of 339 allo-HSCT occurred in (320 children). 51/320 children had gastro-intestinal (GI) flexible endoscopy at a median of 74 (range 20–726) days post-transplant. In total there were 66 theatre bookings for endoscopy. 109 procedures were performed; 64 oesophagogastroduodenoscopy (OGD); 45 colonoscopy (8/45 complete to caecum). On 43 events, OGD and colon’ were performed concurrently. There were significant complications on 3/66 events: 1 patient developed septic shock requiring intensive care; 1 patient developed a duodenal haematoma; 1 patient had gastro-intestinal bleeding that required therapeutic endoscopy. Within 4 weeks of endoscopy, two patients died from multi-organ failure after sequelae of disease and its treatment.Theatre bookings were primarily to investigate for GI-GvHD; 37/61 had skin GvHD at the time of endoscopy. At 43 of the endoscopy episodes children were not receiving systemic steroids; 25 did not have GI-GvHD on histology, 18 did. At 23 of the endoscopy episodes children were already receiving systemic steroids; 8 did not have GI-GvHD on histology, 15 did.ConclusionEndoscopy induced a change in direction of IST on 22 episodes: 18/43 patients were not receiving systemic steroids and had increased IST after detection of GI-GvHD; 4/23 patients already receiving steroids had IST reduced following the absence of GI-GvHD on histology. Overall, clinicians felt the procedu