Introduction: The findings during endoscopy in acute cellular rejection (ACR) are well-known, but a grading system for its severity is lacking. Gothenburg Intestinal Transplant Endoscopy Score (GITES) is a novel, five-stage endoscopic score aiming to describe and categorize the endoscopic findings after intestinal transplantation. The aim with this study was to establish the usefulness of GITES in diagnosing acute cellular rejection. This could result in a more objective evaluation of the endoscopic findings and subsequently an earlier diagnosis of rejection

Methods: We prospectively graded the endoscopic findings with GITES in 13 adult patients (3 isolated intestinal grafts,10 multivisceral grafts) at one single center using white light high definition endoscopy systems. The scoring was performed at the time of endoscopy and later correlated to the histological findings.

Results: Eighty-five ileoscopies were scored. In 52 (61%) cases the endoscopic findings were normal. Twenty-three (69%) out of the 33 abnormal endoscopies revealed mild alterations represented by mild/moderate edema, erythema or blunted villi (GITES 1 and 2). Acute rejection was found in biopsies from 11 (14%) endoscopy sessions (4 mild & 7 moderate/severe) and in three specimens the biopsies revealed CMV enteritis. GITES above 1 (erythema, edematous villi) had 91% sensitivity and 94% specificity for ACR whereas positive (PPV) and negative predictive values (NPVs) were 78% and 98%, respectively. During moderate and severe ACR, GITES revealed an 87% sensitivity and 94% specificity whereas positive (PPV) and negative predictive values (NPVs) were 78% and 98% respectively.

Conclusions: These results suggest that evaluation of the endoscopic findings with GITES results in a satisfactory identification and stratification of rejection. A prospective, multicenter evaluation is needed to confirm these findings.