Contribution of small bowel capsule endoscopy to the treatment of post-allo-HSCT enteritis

A 66-year-old, male patient who had received an allogeneic hematopoietic stem cell transplantation for mantle cell lymphoma had watery diarrhea due to gastrointestinal graft-versus-host disease (GI-GVHD) and cytomegalovirus (CMV) enteritis. Two months later, the diarrhea recurred with thrombocytopenia, and his activities of daily living (ADL) declined. As colonoscopy was deemed too invasive, small bowel capsule endoscopy (SBCE) was performed and found villous regeneration and map-like ulcers indicating improved GVHD and exacerbated CMV enteritis, respectively. CMV-directed therapy with tapering of GVHD treatment improved the diarrhea and ADL. This case highlights the utility of SBCE as a non-invasive tool for guiding treatment decisions in allo-HSCT patients with a poor, general condition.