The Utility of Virtual Chromoendoscopy versus White Light as Compared to H&E and CD31, CD34, CD61 Stains in Differentiating Gastric Antral Vascular Ectasia (GAVE) from Portal Hypertensive Gastropathy

Background: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. Aim: To establish the role of i-scan endoscopy in the diagnosis of PHG. Method: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients. The endoscopic diagnostic criteria for PHG followed the Baveno criteria. The interobserver agreement between white light endoscopy and i-scan endoscopy was determined using Cohen’s kappa statistics. Results: Forty-five of the 50 patients met the diagnostic criteria for PHG when examined by i-scan endoscopy and 39 patients were diagnosed with PHG by white light endoscopy. The strength of agreement between the two methods for the diagnosis of PHG was moderate (k=0.565; 95%CI 0.271-0.859; p<0.001). I-scan 1 classified the mosaic pattern better than classic endoscopy; i-scan 2 described better the red spots. Conclusion: I-scan examination increased the diagnostic sensitivity of PHG. The diagnostic criteria (mosaic pattern and red spots) were easier to observe endoscopically using i-scan than in white light.Abbreviations: FICE: Fuji Intelligent chromoendoscopy; GAVE: gastric antral vascular ectasia; NBI: narrow band imaging; PHG: portal hypertensive gastropathy; PHT: portal hypertension; UGIB: upper gastrointestinal bleeding.

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Gastric Antral Vascular Ectasia and Portal Hypertensive Gastropathy

Stomach Disorders ◽

10.5772/intechopen.70610 ◽

2018 ◽

Author(s):

Daryl Ramai ◽

Sandar Linn ◽

Madhavi Reddy

Keyword(s):

Portal Hypertensive Gastropathy ◽

Gastric Antral Vascular Ectasia ◽

Vascular Ectasia

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Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis

Gut ◽

10.1136/gut.42.5.750 ◽

1998 ◽

Vol 42 (5) ◽

pp. 750-752 ◽

Cited By ~ 40

Author(s):

P A McCormick ◽

H Ooi ◽

O Crosbie

Keyword(s):

Blood Transfusion ◽

Tranexamic Acid ◽

Beta Blockers ◽

Severe Bleeding ◽

Portal Hypertensive Gastropathy ◽

Gastric Antral Vascular Ectasia ◽

Vascular Ectasia ◽

Portal Decompression ◽

Gastrointestinal Blood Loss ◽

Bleeding Episodes

Background—It is believed that severe portal hypertensive gastropathy probably accounts for most non-variceal bleeding episodes in patients with cirrhosis. Gastric antral vascular ectasia (GAVE) also occurs in these patients. It is not clear whether it is a variant of portal hypertensive gastropathy or a distinct condition.Patient—A patient, a 66 year od woman, with cirrhosis initially diagnosed as having portal hypertensive gastropathy and subsequently classified as GAVE is described. She required transfusion with a total of 130 units of packed red cells for gastrointestinal blood loss.Results—The bleeding did not respond to portal decompression with TIPS or beta blockers. Following treatment with oral tranexamic acid she has not required further blood transfusion over a period of 30 months.Conclusion—Tranexamic acid may be a useful treatment for refractory bleeding due to gastric antral vascular ectasia in patients with cirrhosis.

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Approach to the management of portal hypertensive gastropathy and gastric antral vascular ectasia

Clinical Liver Disease ◽

10.1002/cld.99 ◽

2012 ◽

Vol 1 (5) ◽

pp. 163-167 ◽

Cited By ~ 3

Author(s):

Bezawit D. Tekola ◽

Stephen Caldwell

Keyword(s):

Portal Hypertensive Gastropathy ◽

Gastric Antral Vascular Ectasia ◽

Vascular Ectasia

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Portal Hypertension and Variceal Hemorrhage

10.2310/gastro.5497 ◽

2015 ◽

Author(s):

Amir Qamar

Keyword(s):

Portal Hypertension ◽

Natural History ◽

Esophageal Varices ◽

Variceal Hemorrhage ◽

Portal Hypertensive Gastropathy ◽

Gastric Antral Vascular Ectasia ◽

Esophageal Variceal ◽

Gastroesophageal Varices ◽

Vascular Ectasia ◽

History Of

Gastrointestinal bleeding in patients with cirrhosis can occur from a number of different causes, including portal hypertension, gastric antral vascular ectasia, and acute variceal hemorrhage. The management of these conditions involves a combined medical and endoscopic approach, with radiologic and surgical therapies restricted to refractory cases. This review covers the natural history of gastroesophageal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia; diagnostic principles; primary and secondary prophylaxis relating to esophageal variceal hemorrhage; and treatment overviews for gastric variceal hemorrhage, portal hypertensive gastropathy, and gastric antral vascular ectasia. Figures show the pathophysiology of complications of cirrhosis, esophageal varices as seen during an upper endoscopic procedure, natural history of esophageal varices in patients with cirrhosis, portal hypertensive gastropathy, gastric antral vascular ectasia, and management principles for acute variceal hemorrhage, esophageal variceal ligation, and gastric varices. Tables list the prevalence of various etiologies of hemorrhage in patients with cirrhosis, current recommendations for follow-up screening and surveillance of varices, sensitivities and specificities of some noninvasive markers, and principles of initial management of acute variceal hemorrhage. This review contains 8 highly rendered figures, 4 tables, and 44 references.

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