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Endoscopic versus Histopathologic Agreement in the Diagnosis of Gastric Antral Vascular Ectasia


Louissaint, Jeremy MD; Blais, Pierre MD; Chen, Chien-Huan MD, PhD; Lisker-Melman, Mauricio MD

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S316-S317
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Introduction: Gastric Antral Vascular Ectasia (GAVE) is an infrequent etiology of gastrointestinal bleeding, yet those impacted by the disease may face a chronic and debilitating clinical course. GAVE is suspected based on endoscopic criteria but confirmation frequently relies on histopathological findings; however, a large analysis correlating biopsy and endoscopy requires investigation.

Histopathologic Diagnosis of “Other” included Granulation Tissue, Reactive Changes, GVHD, Fundic Gland Polyp, or Normal specimen.
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Methods: This retrospective study was performed using patient data obtained from the Washington University Center for Biomedical Informatics database. Inclusion criteria: age >18 years, ICD-9 or ICD-10 codes for GAVE, and an esophagogastroduodenoscopy performed between January 2005 and October 2016. Chart review was conducted to identify patients with endoscopic GAVE and from this population, gastric biopsy reports were reviewed to determine the histopathologic diagnosis. Patients were excluded if they did not have an endoscopy with documented suspicion of GAVE or if biopsies were not obtained. Nominal and ordinal data were compared using Chi-Square tests and Student's t-tests, respectively. A P=<0.05 was considered statistically significant.

Results: A total of 264 patients were identified with documented endoscopic GAVE. Of this population, 44 patients had the endoscopic diagnosis of GAVE with concurrent biopsies obtained for histopathologic diagnosis. Fifteen patients had cirrhosis; NASH (n=7) and alcohol-related (n=5) cirrhosis were the most common etiologies. A total of 49 endoscopies - two patients had three endoscopies and one patient had two endoscopies noting GAVE with biopsies obtained - with gastric biopsies were performed; histology agreed with the endoscopic suspicion of GAVE in 16 of 49 cases (33%). Cirrhosis was more prevalent in the endoscopic-histopathologic agreement group compared to the disagreement group without reaching statistical significance (P=0.402). There was a higher prevalence of CREST/Scleroderma in the agreement group with a trend toward significance (P=0.052). In the disagreement group, common non-GAVE histopathologic diagnoses included portal hypertensive gastropathy, reactive gastropathy, chronic inflammation, and chronic gastritis.

Conclusion: This retrospective study illustrates the low agreement between endoscopic and histopathologic identification of GAVE. Successful treatment of GAVE relies on its correct identification; therefore, prospective studies are needed in order to corroborate these results and further investigate this often debilitating disorder.

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