Gastric mucosal surface in cirrhosis evaluated by magnifying endoscopy andscanning electronic microscopy

Background and Study Aims: Gastric mucosa may have several tiny patterns in portal hypertension. In this prospective study we used magnifying endoscop y and scanning electron microscopy (SEM) to better characterize the morphol ogy of gastric mucosa in patients with cirrhosis, and we evaluated the diag nostic accuracy of magnifying endoscopy. Patients and Methods: Videotapes of gastric mucosal patterns from 39 cirrho tic patients and 20 control patients were blindly evaluated by the same obs erver using magnifying endoscopy (magnification x15) and conventional endos copy. SEM was performed in 12 other patients. The basic anatomical entities of the gastric architecture on conventional endoscopy were the gastric are a 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. Tn the body, the mosaic pattern, white spots, and red marks were significantly more freq uent in cirrhotic patients, whereas gastric areas were more frequent in con trol patients. Concerning the contributions of the techniques, significantl y more gastric areas were identified by magnifying endoscopy than by conven tional endoscopy: However, in multivariate analysis, only conventional endo scopy with esophageal varices had significant independent diagnostic accura cy for cirrhosis, and magnifying endoscopy of mucosal signs did not add any significant information. SEM did not improve discrimination between contro l and cirrhotic patients. Conclusions: Magnifying endoscopy provides more details of the mucosa, thus improving the delineation of gastric mucosal morphology However, magnifyin g endoscopy has little clinical value in cirrhosis since it does not improv e an the accuracy of conventional endoscopy for the diagnosis of cirrhosis.