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Endoscopic ultrasound in the monitoring of the intestinal allograft

OBJECTIVE: Chronic 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...

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Autores principales: Oltean, Mihai, Hedenström, Per, Varkey, Jonas, Herlenius, Gustaf, Sadik, Riadh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783822/
https://www.ncbi.nlm.nih.gov/pubmed/35058273
http://dx.doi.org/10.1136/bmjgast-2021-000792
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author Oltean, Mihai
Hedenström, Per
Varkey, Jonas
Herlenius, Gustaf
Sadik, Riadh
author_facet Oltean, Mihai
Hedenström, Per
Varkey, Jonas
Herlenius, Gustaf
Sadik, Riadh
author_sort Oltean, Mihai
collection PubMed
description OBJECTIVE: Chronic 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. DESIGN: In 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. RESULTS: EUS 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. CONCLUSION: EUS 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.
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spelling pubmed-87838222022-02-04 Endoscopic ultrasound in the monitoring of the intestinal allograft Oltean, Mihai Hedenström, Per Varkey, Jonas Herlenius, Gustaf Sadik, Riadh BMJ Open Gastroenterol Intestinal Failure OBJECTIVE: Chronic 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. DESIGN: In 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. RESULTS: EUS 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. CONCLUSION: EUS 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. BMJ Publishing Group 2022-01-20 /pmc/articles/PMC8783822/ /pubmed/35058273 http://dx.doi.org/10.1136/bmjgast-2021-000792 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Intestinal Failure
Oltean, Mihai
Hedenström, Per
Varkey, Jonas
Herlenius, Gustaf
Sadik, Riadh
Endoscopic ultrasound in the monitoring of the intestinal allograft
title Endoscopic ultrasound in the monitoring of the intestinal allograft
title_full Endoscopic ultrasound in the monitoring of the intestinal allograft
title_fullStr Endoscopic ultrasound in the monitoring of the intestinal allograft
title_full_unstemmed Endoscopic ultrasound in the monitoring of the intestinal allograft
title_short Endoscopic ultrasound in the monitoring of the intestinal allograft
title_sort endoscopic ultrasound in the monitoring of the intestinal allograft
topic Intestinal Failure
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783822/
https://www.ncbi.nlm.nih.gov/pubmed/35058273
http://dx.doi.org/10.1136/bmjgast-2021-000792
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