TY - JOUR
T1 - Surgical treatment of intestinal complications of graft versus host disease in the pediatric population
T2 - Case series and review of literature
AU - Gutierrez, Camille A.
AU - Raval, Mehul V.
AU - Vester, Hannah R.
AU - Chaudhury, Sonali
AU - von Allmen, Daniel
AU - Rothstein, David H.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Background/purpose Intestinal complications of acute graft-versus-host disease (aGVHD) include hemorrhage and perforation in the short-term, and stricture with bowel obstruction in the long-term. As medical management of severe aGVHD has improved, more patients are surviving even advanced stages of intestinal aGVHD. This review summarizes the available pediatric literature on surgical treatment of complications of intestinal GVHD. Methods A systematic review was performed using PubMed, Cochrane, Embase, and Scopus databases. Any publication that addressed surgical treatment of acute and chronic intestinal GVHD in the pediatric population was reviewed in detail. Furthermore, we included information on 5 additional patients from the institutions of this review's authors, which had not been previously published. Results We identified 8 studies, comprising 13 patients. Surgical interventions were undertaken for a variety of intestinal GVHD complications, including small bowel obstruction owing to stricture (n = 8), enterocutaneous fistulae (n = 2), gastrointestinal hemorrhage/perforation (n = 1 each), and esophageal stricture (n = 1). Among eight patients with bowel obstruction as an indication, pathology revealed ulceration with fibrosis in all but one; 3 had signs of persistent GVHD. Surgical mortality was reported in 4 patients (31%) at an average of 6 weeks postoperatively. The median overall follow-up time was 20 months (IQR, 2–21). Conclusions Although intestinal aGVHD management is almost exclusively medical, a small subset of patients develops complications of intestinal GVHD that require surgical intervention. With expanding indications for stem cell transplantation as well as improved survival after previously fatal bouts of intestinal aGVHD, it is likely that surgical intervention will become more common in these complicated patients. Systematic review Level of Evidence: Level IV.
AB - Background/purpose Intestinal complications of acute graft-versus-host disease (aGVHD) include hemorrhage and perforation in the short-term, and stricture with bowel obstruction in the long-term. As medical management of severe aGVHD has improved, more patients are surviving even advanced stages of intestinal aGVHD. This review summarizes the available pediatric literature on surgical treatment of complications of intestinal GVHD. Methods A systematic review was performed using PubMed, Cochrane, Embase, and Scopus databases. Any publication that addressed surgical treatment of acute and chronic intestinal GVHD in the pediatric population was reviewed in detail. Furthermore, we included information on 5 additional patients from the institutions of this review's authors, which had not been previously published. Results We identified 8 studies, comprising 13 patients. Surgical interventions were undertaken for a variety of intestinal GVHD complications, including small bowel obstruction owing to stricture (n = 8), enterocutaneous fistulae (n = 2), gastrointestinal hemorrhage/perforation (n = 1 each), and esophageal stricture (n = 1). Among eight patients with bowel obstruction as an indication, pathology revealed ulceration with fibrosis in all but one; 3 had signs of persistent GVHD. Surgical mortality was reported in 4 patients (31%) at an average of 6 weeks postoperatively. The median overall follow-up time was 20 months (IQR, 2–21). Conclusions Although intestinal aGVHD management is almost exclusively medical, a small subset of patients develops complications of intestinal GVHD that require surgical intervention. With expanding indications for stem cell transplantation as well as improved survival after previously fatal bouts of intestinal aGVHD, it is likely that surgical intervention will become more common in these complicated patients. Systematic review Level of Evidence: Level IV.
KW - GVHD
KW - Hemorrhage
KW - Intestinal complications
KW - Obstruction
KW - Pediatric surgery
KW - Perforation
UR - http://www.scopus.com/inward/record.url?scp=85023633113&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85023633113&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2017.06.022
DO - 10.1016/j.jpedsurg.2017.06.022
M3 - Review article
C2 - 28711168
AN - SCOPUS:85023633113
SN - 0022-3468
VL - 52
SP - 1718
EP - 1722
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 11
ER -