Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 2168-2178
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2168
Accuracy of virtual chromoendoscopy in differentiating gastric antral vascular ectasia from portal hypertensive gastropathy: A proof of concept study
Ahmad M Al-Taee, Mark P Cubillan, Alice Hinton, Lindsay A Sobotka, Alex S Befeler, Christine Y Hachem, Hisham Hussan
Ahmad M Al-Taee, Division of Gastroenterology and Hepatology, NYU Langone Health, New York, NY 10016, United States
Mark P Cubillan, Department of Internal Medicine, Saint Louis University, St Louis, MO 63110, United States
Alice Hinton, Division of Biostatistics, The Ohio State University, Columbus, OH 43210, United States
Lindsay A Sobotka, Hisham Hussan, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, OH 43210, United States
Alex S Befeler, Christine Y Hachem, Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, MO 63110, United States
Author contributions: Hussan H, Befeler AS, and Hachem CY performed the conceptualization and methodology; Al-Taee AM and Cubillan MP contributed to the data collection; Hinton A performed the data analysis; Al-Taee AM, Cubillan MP, and Sobotka LA contributed to writing-original draft preparation; all authors contributed to writing, reviewing and editing.
Institutional review board statement: The study protocol was approved by the Saint Louis University Institutional Review Board.
Informed consent statement: The study protocol, patient’s rights and obligations were reviewed with eligible patients and informed consent was obtained from all participants.
Conflict-of-interest statement: The authors have no relevant conflicts of interest, including relevant financial interests, activities, relationships, or affiliations.
Data sharing statement: All individual participant data collected during the trial, after deidentification.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ahmad M Al-Taee, MD, Academic Fellow, Division of Gastroenterology and Hepatology, NYU Langone Health, 530 First Ave, HCC 4G, New York, NY 10016, United States.
Received: February 27, 2021
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
Research background

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are two not uncommon causes of upper gastrointestinal bleeding in patients with cirrhosis. While endoscopic appearance can suggest the diagnosis, gastric biopsies are the current gold standard for differentiating PHG from GAVE.

Research motivation

Distinguishing GAVE from PHG is important as the management is different for the two conditions. Obtaining gastric biopsies to diagnose GAVE and PHG may be contraindicated given coagulopathy or thrombocytopenia which are commonly seen with cirrhosis. Here we hypothesized that I-scan virtual chromoendoscopy is more sensitive and specific than high-definition white light endoscopy (HDWLE) at diagnosing GAVE when compared to gastric biopsy.

Research objectives

The main objective of this work was to determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and PHG.

Research methods

We developed an I-scan virtual chromoendoscopy criteria for diagnosis of GAVE and PHG. We then tested these criteria in a prospective cohort of cirrhotic adults with GAVE and PHG when HDWLE diagnosis was in doubt. We then compared the accuracy of I-scan vs HDWLE alone compared to histology.

Research results

I-scan with magnification demonstrated superior overall performance characteristics for real-time visual diagnosis of PHG and GAVE compared to HDWLE in patients with cirrhosis and ambiguous findings on endoscopic evaluation.

Research conclusions

This novel finding allows for an accurate, real time diagnosis in multiple critical clinical situations, such as when biopsy is contraindicated or when more urgent decisions regarding endoscopic management of gastrointestinal bleeding is needed.

Research perspectives

Utilizing I-scan with magnification may obviate the need for biopsies when visual diagnosis of either PHG or GAVE can be made with high confidence. This pilot work supports the further evaluation of I-scan in these challenging clinical situations using a larger sample size and a follow up of outcomes in a randomized fashion.