Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2168
Peer-review started: February 27, 2021
First decision: May 13, 2021
Revised: August 18, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: December 27, 2021
Accurate detection of gastric antral vascular ectasia (GAVE) is critical for proper management of cirrhosis-related gastrointestinal bleeding. However, endoscopic diagnosis of GAVE can be challenging when GAVE overlaps with severe portal hypertensive gastropathy (PHG).
To determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and PHG.
We developed an I-scan virtual chromoendoscopy criteria for diagnosis of GAVE and PHG. We tested our criteria in a cross-sectional cohort of cirrhotic adults with GAVE and PHG when high-definition white light endoscopy (HDWLE) diagnosis was in doubt. We then compared the accuracy of I-scan vs HDWLE alone to histology.
Twenty-three patients were included in this study (65.2% Caucasians and 60.9% males). Chronic hepatitis C was the predominant cause of cirrhosis (43.5%) and seven adults (30.4%) had confirmed GAVE on histology. I-scan had higher sensitivity (100% vs 85.7%) and specificity (75% vs 62.5%) in diagnosing GAVE compared to HDWLE. This translates into a higher, albeit not statistically significant, accuracy of I-scan in detecting GAVE compared to HDWLE alone (82% vs 70%). I-scan was less likely to lead to an accurate diagnosis of GAVE in patients on dialysis (P < 0.05) and in patients with elevated creatinine (P < 0.05). I-scan had similar accuracy to HDWLE in detecting PHG.
This pilot work supports that virtual chromoendoscopy may obviate the need for biopsies when the presence of GAVE is in doubt. Larger studies are needed to assess the impact of virtual chromoendoscopy on success of endoscopic therapy for GAVE.
Core Tip: Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are two causes of GI bleeding in cirrhosis. Gastric biopsies, which are the gold standard to differentiate the two conditions, may be contraindicated given coagulopathy or thrombocytopenia in cirrhosis. We developed virtual chromoendoscopy (I-scan) criteria for diagnosis of GAVE and PHG. We tested our criteria in a prospective cohort of cirrhotic adults with GAVE and PHG when high-definition white light endoscopy (HDWLE) diagnosis was doubtful. We compared accuracy of I-scan vs HDWLE to histology. Compared to HDWLE, I-scan demonstrated superior performance for real-time diagnosis of PHG and GAVE in cirrhosis.