Magnification Endoscopy as a Reliable Tool for the Early Diagnosis of Rejection in Living Related Small Bowel Transplants

A Case Report

M. V. Misra, K. Bhattacharya, D. J. Nompleggi, M. E. Uknis, Cristiana Rastellini, Luca Cicalese

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The purpose was to determine whether magnification endoscopy (ME) accurately diagnosed rejection in living related small bowel transplants (LRSBTx) during initial morphological adaptation of segmental intestinal grafts. The small bowel recipient was a 44-year-old woman with short gut syndrome following multiple bowel surgeries for familial adenomatous polyposis. ME was enhanced by chromoendoscopy staining. Bowel mucosa was washed with acetic acid and stained with methylene blue for optimal visualization of mucosal villi and to improve the diagnostic yield of biopsies. The recipient underwent surveillance ME with biopsy 16 times through the ileostomy in the first 9 months following transplantation. The recipient developed diarrhea in the postoperative course, which led to the suspicion of rejection. ME findings of patchy villus blunting were consistent with biopsy samples that showed mild acute cellular rejection. Episodes of rejection were treated with high-dose immunosuppressants and steroids. Reversal of rejection was monitored by follow-up ME, which showed increased length of villi and normalization of morphology. Biopsy confirmed these findings. The first endoscopy, at 5 days posttransplant, showed no evidence of intestinal ischemia. LRSBTx involves early morphological adaptation of the recipient small bowel mucosa, characterized by an increased length of villi. ME is a reliable technique to follow adaptation and detect early rejection. The superior imaging of small bowel mucosa created by ME chromoendoscopy enables early diagnosis and delivery of more prompt antirejection therapy to prevent progression of rejection. ME also confirmed that segmental LRSBTx caused minimal ischemic injury to the recipient.

Original languageEnglish (US)
Pages (from-to)1738-1739
Number of pages2
JournalTransplantation Proceedings
Volume38
Issue number6
DOIs
StatePublished - Jul 2006
Externally publishedYes

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Endoscopy
Early Diagnosis
Transplants
Biopsy
Mucous Membrane
Ileostomy
Adenomatous Polyposis Coli
Methylene Blue
Immunosuppressive Agents
Acetic Acid
Immunosuppression
Diarrhea
Ischemia
Transplantation
Steroids
Staining and Labeling
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Magnification Endoscopy as a Reliable Tool for the Early Diagnosis of Rejection in Living Related Small Bowel Transplants : A Case Report. / Misra, M. V.; Bhattacharya, K.; Nompleggi, D. J.; Uknis, M. E.; Rastellini, Cristiana; Cicalese, Luca.

In: Transplantation Proceedings, Vol. 38, No. 6, 07.2006, p. 1738-1739.

Research output: Contribution to journalArticle

Misra, M. V. ; Bhattacharya, K. ; Nompleggi, D. J. ; Uknis, M. E. ; Rastellini, Cristiana ; Cicalese, Luca. / Magnification Endoscopy as a Reliable Tool for the Early Diagnosis of Rejection in Living Related Small Bowel Transplants : A Case Report. In: Transplantation Proceedings. 2006 ; Vol. 38, No. 6. pp. 1738-1739.
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