Endoscopic ultrasound in the monitoring of the intestinal allograft

• Published in: BMJ open gastroenterology Vol. 9; no. 1; p. e000792
• Main Authors: Oltean, Mihai, Hedenström, Per, Varkey, Jonas, Herlenius, Gustaf, Sadik, Riadh
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.01.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Allografts; Biopsy; chronic rejection; endoscopic ultrasonography; Endoscopy; Endosonography; experience; Gastroenterologi; Gastroenterology & Hepatology; Gastroenterology and Hepatology; General anesthesia; Humans; Intestinal Failure; Intestinal Mucosa - diagnostic imaging; Intestinal Mucosa - pathology; intestinal transplantation; Intestine, Small - pathology; muscle; Ostomy; Patients; small-bowel transplantation; surgical complications; Surveillance; Transplantation, Homologous - adverse effects; Transplants & implants; Ultrasonic imaging; Veins & arteries; Japan; surgical complications; endoscopy; endoscopic ultrasonography; intestinal transplantation
• ISSN: 2054-4774; 2054-4774
• DOI: 10.1136/bmjgast-2021-000792

ObjectiveChronic rejection (CR) of the small intestinal allograft includes mucosal fibrosis, bowel thickening and arteriopathy in the outer wall layers and the mesentery. CR lacks non-invasive markers and reliable diagnostic methods. We evaluated endoscopic ultrasound (EUS) as a novel approach for monitoring of the intestinal allograft with respect to CR.DesignIn intestinal graft recipients, EUS and enteroscopy with ileal mucosal biopsy were performed via the ileostomy. At EUS, the wall thickness of the intestinal graft was measured in standard mode, whereas the resistive index (RI) of the supplying artery was assessed in pulsed Doppler mode. At enteroscopy, the intestinal mucosa was assessed. Findings were compared with histopathology and clinical follow-up.ResultsEUS was successfully performed in all 11 patients (adequate clinical course (AC) n=9; CR n=2) after a median interval of 1537 days (range: 170–5204), post-transplantation. The total diameter of the wall (layer I–V) was comparable in all patients. Meanwhile, the diameter of the outermost part (layer IV–V; that is, muscularis propria–serosa) was among the two CR patients (range: 1.3–1.4 mm) in the upper end of measurements as compared with the nine AC patients (range: 0.5–1.4 mm). The RI was >0.9 in both CR patients, while the RI was ≤0.8 in all AC patients. Both CR patients had abnormal findings at enteroscopy and histopathology and deceased during follow-up.ConclusionEUS is a promising tool providing detailed information on the intestinal graft morphology and rheology, which may be used for assessment of potential CR in long-term follow-up of intestinal allograft recipients.