W2023 Endoscopic Visible Light Spectroscopy: A New Minimally Invasive Technique for the Diagnosis of Chronic Gastrointestinal Ischemia

Background Upper gastrointestinal endoscopy is often used as diagnostic method for chronic gastrointestinal ischemia (CGI). This is based on the assumption that patients with symptomatic CGI have typical gastroduodenal abnormalities like erosions/ulcerations and/or paleness. However, little is known about the true prevalence and character of specific gastroduodenal lesions in patients with CGI. This study therefore aimed to investigate upper endoscopic findings in patients with well-defined CGI. Methods Prospectively, consecutive patients suspected for CGI were included. All patients underwent a standard diagnostic work-up existing of gastroduodenoscopy, gastric and jejunal 24 hour tonometry (TM) enabling mucosal CO2measurements both in fasting and post-prandial state, and CT or MR abdominal angiography for defining abdominal arterial stenosis. All diagnostic results were discussed in a multidisciplinary team and a consensus diagnosis on presence or absence of CGI was made. Only patients diagnosed with CGI were included for this study. Endoscopic findings were scored in the stomach, bulbus, and duodenum. They were differentiated in mucosal erythema, edema, paleness, and breaks (erosions/ulcers). Results In 2 years time, 144 patients were analyzed for possible CGI. CGI was diagnosed in 76 patients (53%): 25 males, mean age 62 (17-86) years. Singleand multivessel disease was diagnosed in 43 and 33 patients respectively. Upper endoscopy was performed in 55 patients. Endoscopic pathological findings were found in 34 (62%) of those 55 patients (Table). Typical ischemic lesions (erosions/ ulcerative lesions and/or paleness) were only found in 19 (25%) patients. Mucosal erythema and edema were found most frequently, and were mostly seen in the stomach, in 22 and 13 patients respectively. Conclusions CGI patients often present with non-specific upper endoscopic pathology, only a minority of patients show mucosal breaks and/or paleness during upper gastrointestinal endoscopy. No differences in prevalence and character of pathological findings existed between patients with single versus multiple vessel CGI. These data show that normal endoscopic findings on upper endoscopy have a limited negative predictive value for the presence of CGI. Upper endoscopic findings in 55 CGI patients