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The gastrointestinal tract is the second most commonly involved organ system in graft versus host disease (GvHD) following allogeneic stem cell transplantation, and its involvement is associated with a worse prognosis [1,2]. White light endoscopy findings are nonspecific and often unhelpful in the diagnosis of GvHD and evaluation of its response to therapy. Conventional histological examination of intestinal biopsy samples still represents the gold standard in GvHD diagnosis [3]. Moreover, after allogeneic stem cell transplantation, it could be potentially dangerous to carry out multiple biopsies and may require transfusion of erythrocytes, platelets, or coagulation factors. Here, we describe novel endoscopic findings associated with healing of the colonic mucosa in a patient with GvHD, obtained by high definition (HD+) technology with i-Scan virtual chromoendoscopy (Pentax Medical, Tokyo, Japan). A 42-year-old man, who underwent allogenic sibling stem cell transplantation for chronic lymphocytic leukemia, presented on day 79 with acute symptoms including vomiting, abdominal pain, and diarrhea. Colonoscopy showed multiple ulcers in the left side of the colon. Biopsy specimens were taken and pathological examination revealed colonic GvHD, grade 3/4. The patient was started on high-dose intravenous steroids, followed by antithymocyte globulin (ATG), and – subsequently – extracorporeal photophoresis. Flexible sigmoidoscopy with HD+ and i-Scan virtual chromoendoscopy was carried out to characterize the endoscopic findings of the response to therapy in Fig.1 a,b High definition with i-Scan combination view in a 42-year-old man with a history of allogenic sibling stem cell transplantation. Note the regenerative honeycomb mucosal pattern in the colon. c,d High definition with i-Scan virtual chromoendoscopic view again showing the honeycomb, flowery mucosal pattern and healing ulcer. Fig.2 a,b Histological section showing elongated crypts in the regenerating mucosa (hematoxylin and eosin, magnification×200). Cases and Techniques Library (CTL) E389

endoscopy

Assessment of the early regenerative therapeutic response in graft versus host disease using high definition technology with virtual i-Scan chromoendoscopy