The privilege of I- SCAN over white light Endoscopy in the diagnosis of Portal HypertensiveGastropathy in an Egyptian population.

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Abstract Background: Endoscopic imaging of Portal Hypertensive Gastropathy (PHG) depends on white light endoscopy (WLE). Sometimes WLE may miss many lesions and may cause misinterpretation of findings, leading to delayed or inefficient therapeutic modalities. The aim was to assess the privilege of using I-SCAN over conventional WLE in the diagnosis of PHG among liver cirrhosis patients. One hundred fifty-three patients with cirrhosis and portal hypertension were examined endoscopically with both conventional WLE and I-SCAN modes (1, 2 &3).Results: I-SCAN modes were able to define PHG with higher cut off value for the platelets count and lower cut off values for Portal Vein diameter and splenic size. I-SCAN 2 &3 almost share the ability to detect the red color of the blood vessels, capillaries and submucosal hemorrhage. All I-SCAN modes showed statistically significant difference against WLE in detection of mosaic pattern in fundus of the stomach (P<0.001) with both I-SCAN 1 &2 having the highest true positive rate (95.3%). I-SCAN 2 was the best mode to detect mosaic pattern compared to WLE and other I-SCAN modes with sensitivity 95.3%, specificity 51.9% and accuracy 87.7%. Regarding red spots detection, I-SCAN 2 was the only mode with statistically significant difference against WLE. Although, I-SCAN 3 had the highest true positive rate (75.6%) versus (69.3%) for I-SCAN 2. Both I-SCAN 2 &3 shared sensitivity value 100%. But; regarding the specificity I-SCAN 2 was 52.8% against 39.6% for I-SCAN 3. I-SCAN 3 detected more positive cases with red spots of PHG (72.1%) than WLE and other I-SCAN modes. Regarding the severity both I-SCAN 2 &3 detected the same number of cases with severe red spots (16.9%). Conclusions: I-SCAN 2 is considered a better visualizing modality for PHG and its criteria (mosaic pattern & red spots) in gastric mucosa. Combining magnification technique with I-SCAN functionality could enhance the diagnostic ability depending on the gastric mucosal pit patterns and comparing it to the patterns associated with other diseases.

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