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
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.
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.
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.
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.
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.
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.
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.