Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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:
https://creativecommons.org/Licenses/by-nc/4.0/ 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. ahmad.al-taee@nyulangone.org
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
BACKGROUND
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).
AIM
To determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and PHG.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
