Gastric Mucosal Surface In Cirrhosis Evaluated By Magnifying Endoscopy And Scanning Electronic Microscopy

 

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Background and Study Aims: Gastric mucosa may have several tiny patterns in portal hypertension. In this prospective study, we used magnifying endoscopy and scanning electron microscopy (SEM) to better characterize the morphology of gastric mucosa in patients with cirrhosis, and we evaluated the diagnostic accuracy of magnifying endoscopy.

Patients and Methods: Videotapes of gastric mucosal patterns from 39 cirrhotic patients and 20 control patients were blindly evaluated by the same observer using magnifying endoscopy (magnification × 25) and conventional endoscopy. SEM was performed in 12 other patients. The basic anatomical entities of the gastric architecture on conventional endoscopy were the gastric area in control patients and the mosaic pattern in patients with cirrhosis.

Results: With regard to the prevalence of endoscopic patterns in the antrum, the mosaic pattern was more frequent in cirrhotic patients. In the body, the mosaic pattern, white spots, and red marks were significantly more frequent in cirrhotic patients, whereas gastric areas were more frequent in control patients. Concerning the contributions of the techniques, significantly more gastric areas were identified by magnifying endoscopy than by conventional endoscopy. However, in multivariate analysis, only conventional endoscopy with esophageal varices had significant independent diagnostic accuracy for cirrhosis, and magnifying endoscopy of mucosal signs did not add any significant information. SEM did not improve discrimination between control and cirrhotic patients.

Conclusions: Magnifying endoscopy provides more details of the mucosa, thus improving the delineation of gastric mucosal morphology. However, magnifying endoscopy has little clinical value in cirrhosis since it does not improve on the accuracy of conventional endoscopy for the diagnosis of cirrhosis.

Buts de l'Étude: La muqueuse gastrique peut avoir plusieurs aspects minuscules au cours de l'hypertension portale. Dans cette étude prospective, nous avons utilisé l'endoscopie grossissante et la microscopie électronique à balayage (MEB) afin de mieux définir la morphologie de la muqueuse gastrique chez les malades avec cirrhose et nous avons évalué la performance diagnostique de l'endoscopie grossissante.

Patientes et Méthodes: Les vidéo-enregistrements des aspects de muqueuse gastrique de 39 malades cirrhotiques et de 20 malades témoins ont été évalués en aveugle par le même observateur en utilisant l'endoscopie grossissante (grossissement: 25) et l'endoscopie conventionnelle. La MEB a été utilisée chez 12 autres malades. Les éléments anatomiques de base de l'architecture gastrique en endoscopie grossissante étaient les aires gastriques chez les malades témoins et l'aspect en mosaïque chez les malades cirrhotiques.

Résultats: (a) Prévalence des aspects endoscopiques: dans l'antre, l'aspect en mosaïque était plus fréquent chez les patients cirrhotiques. Dans le corps l'aspect en mosaïque, les points blancs et les signes rouges étaient significativement plus fréquents chez les patients cirrhotiques tandis que les aires gastriques étaient plus fréquentes chez les malades témoins. (b) Contribution des techniques: l'endoscopie grossissante identifiait significativement plus d'aire gastrique que l'endoscopie conventionnelle. Cependant, en analyse multivariée, seule l'endoscopie conventionnelle avec les varices oesophagiennes avait une performance diagnostique indépendante significative pour la cirrhose, alors que l'endoscopie grossissante des signes muqueux n'apportait pas d'information significative. La MEB ne permettait pas d'améliorer la discrimination entre les malades témoins et cirrhotiques.

Conclusions: L'endoscopie grossissante fournit davantage de détails de la muqueuse, améliorant ainsi la description de la morphologie de la muqueuse gastrique. Cependant, l'endoscopie grossissante a peu d'intérêt clinique au cours de la cirrhose car elle n'améliore pas la performance diagnostique de l'endoscopie conventionnelle pour le diagnostic de cirrhose.

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M.D. Paul Calès

Service d'Hépato-Gastroentérologie CHU

49033 Angers Cedex 01

France

Phone: +33-2-41354119

Email: Paul.Cales@med.univ-angers.fr