ROLE OF UPPER ENDOSCOPY IN EVALUATION OF UPPER GASTROINTESTINAL SYMPTOMS IN PATIENTS UNDERGOING BONE-MARROW TRANSPLANTATION

We reviewed our upper endoscopy (esophagogastroduodenoscopy, EGD) expe rience in a group of 65 consecutive patients receiving carmustine (BCN U) 600 mg/m(2), cisplatin 200 mg/m(2), VP-16 2400 mg/m(2), and autolog ous bone marrow transplantation (BMT) for relapsed or refractory non-H odgkin's lymphoma or Hodgkin's disease. Forty-one patients (33 with ch est irradiation) underwent 48 EGDs for the following symptoms: upper g astrointestinal bleeding (melena and/or hematemesis) (12/48); persiste nt nausea and vomiting (7/48); odynophagia (25/48); and dysphagia (14/ 48). All patients who had dysphagia or odynophagia had endoscopic evid ence of severe esophagitis, with confluent erosions or ulcerations. Ga strointestinal bleeding, which presented as melena or hematemesis, was caused by severe esophagitis in 11 of 12 patients. Yeasts were detect ed in 11/42 histological, or cytological specimens and were isolated i n 4/26 cultures. No bleeding or infectious complications occurred in a ny patient as a result of the EGD procedure. We conclude that severe e sophagitis documented by EGD is common in lymphoma patients receiving autologous BMT. Use of EGD, however, did not affect the decision to in itiate empirical therapy with amphotericin B for persistent fever.