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Enteroscopic Biopsies in the Management of Pancreas Transplants: A Proof of Concept Study for a Novel Monitoring Tool

Margreiter, Christian1,3; Aigner, Felix1; Resch, Thomas1; Berenji, Anna-Katharina1; Oberhuber, Rupert1; Sucher, Robert1; Profanter, Christoph1; Veits, Lothar2; Öllinger, Robert1; Margreiter, Raimund1; Pratschke, Johann1; Mark, Walter1

doi: 10.1097/TP.0b013e31823cf953
Clinical and Translational Research

Background. Although percutaneous biopsies are considered to be the gold standard in diagnosing pancreas graft rejection, they are not performed routinely because of their association with severe complications. On the other hand, correct diagnosis of rejection is essential but may be difficult in cases of enteric drainage, particularly in patients with a pancreas transplant alone or a pancreas after kidney transplant.

Methods. Pancreas recipients who underwent enteroscopy between May 2005 and September 2009 were included in this retrospective analysis. Biopsies were graded 0 to 4 for interstitial and vascular changes.

Results. During the study period a total of 65 simultaneous pancreas-kidney transplants, 13 pancreas after kidney transplants and 4 pancreas transplants alone were performed. Sixty-three patients underwent a single enteroscopy, 10 had two, and 6 had three or more. Indications were protocol graft monitoring (n=73), graft dysfunction (n=17), enteric hemorrhage (n=9), or other (n=3). The duodenal segment was accessed in 76 instances (75%) with abnormal findings in 23. A total of 69 biopsies were obtained and revealed normal mucosa in 49 cases (71%). Histology showed signs of acute rejection in 11 cases. The upper gastrointestinal tract was also assessed, and, in 13 cases, additional pathologies were identified including gastroduodenitis (n=10), gastric/duodenal ulcer (n=2), and hemorrhagic esophagitis (n=1). No procedure-related complication occurred.

Conclusions. This series of enteroscopies demonstrates that the duodenal segment of a pancreatic graft is accessible using our implant technique, and thus permitting biopsies to be obtained and endoscopic interventions to be performed.

1Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.

2Department of Pathology, Innsbruck Medical University, Innsbruck, Austria.

The authors declare no funding or conflicts of interest.

Address correspondence to: Christian Margreiter, M.D., Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail:

C.M., F.A., J.P., W.M., and R.M. participated in writing the manuscript. W.M. participated in research design. C.P., R.Ö., and L.V. participated in performance of the research. T.R., R.O., A.-K.B., and R.S. participated in data analysis.

Received 25 July 2011. Revision requested 15 August 2011.

Accepted 10 October 2011.

© 2012 Lippincott Williams & Wilkins, Inc.