A PROSPECTIVE-STUDY OF SCREENING UPPER GASTROINTESTINAL (GI) ENDOSCOPY PRIOR TO AND AFTER BONE-MARROW TRANSPLANTATION (BMT)

Background: Upper gastrointestinal (GI) endoscopic abnormalities are c ommon in symptomatic bone marrow transplant (BMT) recipients but the i ncidence of occult gastrointestinal disease in these patients is unkno wn. Aims: To examine the role of screening upper GI endoscopy before a nd after BMT. Methods: Endoscopy was performed routinely on allogeneic (n = 24) and autologous (n = 17) BMT patients before transplant and a t 30 and 120 days after transplant. Results: Twenty-one of 41 patients (51%) had an endoscopic abnormality on one or more occasions which ne cessitated a change in treatment. These abnormalities were present in ten of 41 (24%) pre-transplant endoscopies, ten of 32 (31%) endoscopie s at day 30 after BMT, and in seven of 22 (32%) day 120 endoscopies. A bnormalities included mucosal erosions or ulcers (n = 22 endoscopies), infections (n = 5) or previously undiagnosed GI graft-versus-host dis ease (n = 3). Mucosal erosions or ulcers were present in eight of 28 e ndoscopies despite regular anti ulcer drug therapy. Conclusions: Scree ning upper GI endoscopy before and after BMT is generally safe and det ects a high yield of significant GI abnormalities. However, it remains to be demonstrated that treatment of these lesions will improve the c linical outcome in BMT recipients without GI symptoms.