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. 2022;12(1):34.
doi: 10.1186/s43066-022-00198-9. Epub 2022 Jun 10.

The classification of gastric antral vascular ectasia in cirrhotic patients by Versatile Intelligent Staining Technology

Randa Salah Eldin Abdelmoneim  1 , Amr Aly Abdelmoety  1 , Nahed Baddour  2 , Perihan Salem  1 , Marwa Metawea  1
Affiliations

The classification of gastric antral vascular ectasia in cirrhotic patients by Versatile Intelligent Staining Technology

Randa Salah Eldin Abdelmoneim et al. Egypt Liver J. 2022.

Abstract

Background: Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are two different pathologies that cause bleeding in cirrhotic patients. These two pathologies are still difficult to be distinguished by white light endoscopy (conventional), as they both appear as red spots in the gastric antral mucosa in the case of severe PHG. The aim of our study was to assess the efficacy of Versatile Intelligent Staining Technology (VIST) in comparison to histopathology in the diagnosis and classification of GAVE.

Methods: A cross-sectional study included 50 patients with liver cirrhosis recruited from Alexandria Main University Hospital. Patients with connective tissue diseases and chronic kidney disease were excluded. All patients were examined by both conventional white light endoscopy (WLE) and image enhancement technology (VIST) using Sonoscape HD500 endoscope. GAVE was diagnosed as tortuous columns of ectatic vessels in the gastric antrum. Histopathological examination was used as the standard tool for the diagnosis of GAVE.

Results: A total of 50 patients were included, 28 patients (56 %) were diagnosed as GAVE by pathology vs 22 (44 %) as non-GAVE. Twenty-three of 28 (78.6 %) cases of GAVE were detected by VIST. VIST had superior sensitivity than WLE in the detection of GAVE, 82.1 % vs 7.1 %, while WLE had higher specificity 95.5 % vs 59.1 % by VIST. There was statistical significance between VIST and pathology in the diagnosis of GAVE, p<0.035, but no statistical significance between WLE and pathology. VIST has identified two types of GAVE: focal in 12/28 cases and diffuse in 11/28, and five were not diagnosed by VIST.

Conclusions: Versatile Intelligent Staining Technology could be used as an alternative tool to histopathological diagnosis of GAVE. GAVE can present as a focal group of ectatic vessels which adds a new class to GAVE classification that was previously misdiagnosed.

Keywords: Gastric antral vascular ectasia; Portal hypertensive gastropathy; Versatile Intelligent Staining Technology; White light endoscopy.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
WLE and VIST view of two forms of GAVE found in the studied patients: (1&2) GAVE diffuse type and (3&4) GAVE focal type respectively
Fig. 2
Fig. 2
Gastric antral biopsy showing signs of GAVE; fibrosis of the lamina propria with fibrin thrombi in the small vessels (H & E, ×400)
See this image and copyright information in PMC

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