Our Summary

The research paper is a review of 23 years of endoscopy procedures performed on children who have received intestinal transplants. Endoscopy is a procedure where a small camera is used to look inside the body, in this case, the intestine. The study looked at the reasons for the procedures, what was found, and any complications that occurred.

They performed 1770 procedures on children, most often to look at the esophagus, stomach, and beginning of the small intestine, as well as the end of the small intestine. The most common reasons for these procedures were either because the child was having increased bowel movements or as a routine check-up.

There were 162 cases where the biopsies taken during the procedures showed that the body was rejecting the transplanted intestine. The first rejection usually occurred within the first month after the transplant. Interestingly, in almost half of these rejection cases, the intestine looked normal under endoscopy.

The rate of complications from these procedures, such as bleeding or perforation of the intestine, was 1.8%. The researchers concluded that endoscopy with biopsy is crucial in the care of children who have received intestinal transplants, even though these procedures have higher complication rates than in children without intestinal transplants.

They also concluded that a normal-looking intestine does not necessarily mean it’s not being rejected. Therefore, these procedures should be performed in specialized centers by experienced pathologists. The researchers suggest that development of a non-invasive method to detect rejection would be beneficial.

FAQs

  1. What are the most common reasons for conducting endoscopy procedures on children who have received intestinal transplants?
  2. What were the findings regarding the body’s rejection of the transplanted intestine?
  3. What was the rate of complications from these endoscopy procedures and what did the researchers conclude from this?

Doctor’s Tip

A doctor might advise a patient who has received an intestinal transplant to regularly undergo endoscopy procedures to monitor the health of the transplanted intestine. It is important to have these procedures done by experienced professionals in specialized centers to ensure accurate results and proper care. Additionally, even if the intestine appears normal during endoscopy, it does not necessarily mean rejection is not occurring, so regular monitoring is crucial. Developing a non-invasive method to detect rejection would be beneficial in the future.

Suitable For

Patients who are typically recommended for intestinal transplant are those with irreversible intestinal failure, which may be caused by conditions such as short bowel syndrome, chronic intestinal pseudo-obstruction, or congenital defects of the intestine. These patients may not be able to absorb enough nutrients from food or may have complications such as frequent infections or liver disease. Intestinal transplant may be considered when other treatments, such as parenteral nutrition or bowel lengthening surgeries, are not successful in improving the patient’s condition.

Timeline

  • Before intestinal transplant: The patient undergoes a series of medical evaluations to determine if they are a suitable candidate for a transplant. This includes blood tests, imaging studies, and consultations with a transplant team. Once approved, the patient is placed on a waiting list for a donor intestine.

  • Day of transplant: The patient undergoes a complex surgical procedure to remove the diseased intestine and replace it with a healthy donor intestine. The surgery can last several hours and requires close monitoring in the intensive care unit afterward.

  • First month post-transplant: The patient is closely monitored for signs of rejection or complications. This may involve frequent hospital visits, blood tests, and imaging studies to ensure the new intestine is functioning properly.

  • Endoscopy procedures: In the months and years following the transplant, the patient may undergo regular endoscopy procedures to monitor the health of the transplanted intestine. Biopsies may be taken to check for signs of rejection or other complications.

  • Rejection episodes: If signs of rejection are detected, the patient may require additional treatments such as changes in medication or, in severe cases, another transplant. Repeated endoscopy procedures may be necessary to monitor the response to treatment.

  • Long-term care: Patients who have received an intestinal transplant require lifelong monitoring and care to manage complications and ensure the health of the transplanted intestine. This may include regular follow-up appointments, blood tests, and imaging studies to monitor for signs of rejection or other complications.

Overall, the timeline for a patient before and after an intestinal transplant involves a series of medical evaluations, the transplant surgery itself, post-operative monitoring, regular endoscopy procedures, and long-term care to manage complications and ensure the health of the transplanted intestine.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with intestinal transplant surgery?
  2. How often will I need to undergo endoscopy procedures following the transplant?
  3. What are the signs and symptoms of rejection that I should be aware of?
  4. How will the results of the endoscopy procedures be used to monitor the success of the transplant?
  5. Are there any alternative methods for monitoring rejection other than endoscopy with biopsy?
  6. What steps can I take to reduce the risk of rejection following the transplant?
  7. How long does the recovery process typically take after an intestinal transplant?
  8. What are the long-term implications of living with a transplanted intestine?
  9. Are there any lifestyle changes or dietary restrictions I will need to follow post-transplant?
  10. How frequently will I need to follow up with my transplant team after the surgery?

Reference

Authors: Yeh J, Ngo KD, Wozniak LJ, Vargas JH, Marcus EA, McDiarmid SV, Farmer DG, Venick RS. Journal: J Pediatr Gastroenterol Nutr. 2015 Dec;61(6):636-40. doi: 10.1097/MPG.0000000000000871. PMID: 26020374