Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement^[*]

Abstract

Background and study aims Nomenclature and descriptions of small bowel (SB) vascular lesions in capsule endoscopy (CE) are scarce in the medical literature. They are mostly based on the reader's opinion and thus differ between experts, with a potential negative impact on clinical care, teaching and research regarding SBCE. Our aim was to better define a nomenclature and to give a description of the most frequent vascular lesions in SBCE.

Methods A panel of 18 European expert SBCE readers was formed during the UEGW 2016 meeting. Three experts constructed an Internet-based four-round Delphi consensus, but did not participate in the voting process. They built questionnaires that included various still frames of vascular lesions obtained with a third-generation SBCE system. The 15 remaining participants were asked to rate different proposals and description of the most common SB vascular lesions. A 6-point rating scale (varying from ‘strongly disagree’ to ‘strongly agree’) was used successive rounds. The consensus was reached when at least 80 % voting members scored the statement within the ‘agree’ or ‘strongly agree’.

Results Consensual terms and descriptions were reached for angiectasia/angiodysplasia, erythematous patch, red spot/dot, and phlebectasia. A consensual description was reached for more subtle vascular lesions tentatively named “diminutive angiectasia” but no consensus was reached for this term.

Conclusion An international group has reached a consensus on the nomenclature and descriptions of the most frequent and relevant SB vascular lesions in CE. These terms and descriptions are useful in daily practice, for teaching and for medical research purposes.

• References

• 1 Iddan G, Meron G, Glukhovsky A. et al. Wireless capsule endoscopy. Nature 2000; 405: 417
• 2 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 3 Korman LY, Delvaux M, Gay G. et al. Capsule endoscopy structured terminology (CEST): proposal of a standardized and structured terminology for reporting capsule endoscopy procedures. Endoscopy 2005; 37: 951-959
• 4 Delvaux M, Friedman S, Keuchel M. et al. Structured terminology for capsule endoscopy: results of retrospective testing and validation in 766 small-bowel investigations. Endoscopy 2005; 37: 945-950
• 5 Aabakken L, Rembacken B, LeMoine O. et al. Minimal standard terminology for gastrointestinal endoscopy – MST 3.0. Endoscopy 2009; 41: 727-728
• 6 Becq A, Rahmi G, Perrod G. et al. Hemorrhagic angiodysplasia of the digestive tract: pathogenesis, diagnosis, and management. Gastrointest Endosc 2017; 86: 792-806
• 7 Wassef M, Blei F, Adams D. et al. Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics 2015; 136: e203-214
• 8 Yano T, Yamamoto H, Sunada K. et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008; 67: 169-172
• 9 Pezzoli A, Cannizzaro R, Pennazio M. et al. Interobserver agreement in describing video capsule endoscopy findings: a multicentre prospective study. Dig Liver Dis 2011; 43: 126-131
• 10 Jang BI, Lee SH, Moon J-S. et al. Inter-observer agreement on the interpretation of capsule endoscopy findings based on capsule endoscopy structured terminology: a multicenter study by the Korean Gut Image Study Group. Scand J Gastroenterol 2010; 45: 370-374
• 11 Micic D, Semrad CE. Small bowel endoscopy. Curr Treat Options Gastroenterol 2016; 14: 220-235
• 12 Dalkey N, Helmer O. An experimental application of the DELPHI Method to the use of experts. Management Science 1963; 9: 458-467
• 13 Hsu C-C, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval 2007; 12: 1-8
• 14 Leenhardt R, Li C, Le Mouel JP. et al. CAD-CAP: a 26000 images database serving the development of artificial intelligence for capsule endoscopy. United European Gastroenterology Week, Vienna, 22–24 oct 2018
• 15 Katragadda C, Finnane A, Soyer HP. Technique standards for skin lesion imaging: a delphi consensus statement. JAMA Dermatol 2017; 153: 207-213
• 16 Collins S, Yen P-Y, Phillips A. et al. Nursing informatics competency assessment for the nurse leader: The Delphi Study. J Nurs Adm 2017; 47: 212-218
• 17 Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Info Manag 2004; 42: 15-29
• 18 Rácz I, Jánoki M, Kovács V. Measurement of small-bowel polyp size in patients with Peutz-Jeghers syndrome by using reference granules during video capsule endoscopy. Endoscopy 2007; 1: E41
• 19 Brandt LJ. Terminology for vascular lesions of the GI tract. Gastrointest Endosc 2018; 87: 1595-1596 comment to Becq A, et al. Terminology for vascular lesions of the GI tract. Gastrointest Endosc 2018; 87: 1596