“Snowmelt Sign” and “Corkscrew Microvessels” Predicting Epithelium Regeneration After Acute Rejection of Small-Bowel Transplantation: A Case Report

Intestinal failure characterized by inadequate maintenance of nutrition via normal intestinal function comprises a group of disorders with many different causes. If parenteral nutrition dependency develops, which is associated with higher mortality and complications, it is considered for intestine transplantation. However, the graft failure rate is not low, and acute cellular rejection is one of the most important reasons for graft failure. As a result, early identification of rejection and timely modification of anti-rejection medications have been considered to be associated with better graft and patient survival rates. The diagnostic gold standard for rejection is mainly based on histology, but hours of delay by pathology may occur. Some researchers investigated the association of endoscopic images with graft rejection to provide timely diagnosis. In this study, we present the first case report with characteristic features under magnifying endoscopy with a narrow-band imaging system to predict epithelial regeneration and improvement of graft rejection in a patient with small-bowel transplantation. •Graft failure rate is not low in small bowel transplantation patients and acute cellular rejection is one of the most important reasons for graft failure.•Early identification of rejection and timely modification of anti-rejection medications is considered to be associated with better graft and patient survivals.•Using characteristic features under magnifying endoscopy with narrow-band imaging system can predict epithelial regeneration and improvement of graft rejection and avoid unnecessary biopsy or immunosuppressants in small bowel transplantation patients.