The misclassification of gastric antral vascular ectasia
Background: Gastric antral vascular ectasia (GAVE) is characterized by angiodysplastic lesions and is a rare form of gastrointestinal bleeding. Given the multiple patterns, GAVE can be misclassified
Aim: We analyzed the misclassification of GAVE amongst patients undergoing esophagogastroduodenoscopy (EGD)
Methods: We performed a retrospective review of 941 EGDs between 2017-2019. Inclusion criteria included findings of GAVE on EGD ± biopsy. Correct classification was based on visual EGD findings. Outcome variables included misclassification rate, endoscopist’s background, and concordance between EGD and pathology. Cohen’s Kappa test was used for concordance analysis.
Results: A total of 110 patients had EGD findings of GAVE with a corresponding 184 EGDs. The misclassification rate amongst EGDs was 74/184 (40%). Furthermore, 81/110 patients were correctly classified with their first workup, whereas 29/110 patients needed repeat testing. In cases of misclassification, GAVE was mostly referred to as erythema (43%), with ulceration, gastritis, or polyps. Sixty-six (60%) patients had biopsies with a concordance of 76% between EGD and biopsy (κ=0.35)
Conclusions: Our findings indicate GAVE was misclasssified up to 40% on EGDs with hepatologists and gastroenterologists having similar misclassification rates. Proper identification is crucial given susceptibility to upper gastrointestinal bleeding.
Relevance for patients: This study emphasizes the importance of accurate classification of GAVE to ensure proper treatment of these lesions which can improve clinical outcomes.
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