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

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          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.

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          The Delphi method as a research tool: an example, design considerations and applications

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            Wireless capsule endoscopy.

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              Endoscopic classification of vascular lesions of the small intestine (with videos).

              Small-intestinal vascular lesions observed by endoscopy vary in appearance. Angioectasia is a venous lesion that requires cauterization; a Dieulafoy's lesion and arteriovenous malformation may cause arterial bleeding, which requires clipping or laparotomy. For selection of the appropriate treatment, it is necessary to distinguish between venous and arterial lesions. We classified these lesions into the following 6 groups: type 1a, punctulate erythema (< 1 mm), with or without oozing; type 1b, patchy erythema (a few mm), with or without oozing; type 2a, punctulate lesions (< 1 mm), with pulsatile bleeding; type 2b, pulsatile red protrusion, without surrounding venous dilatation; type 3, pulsatile red protrusion, with surrounding venous dilatation; type 4, other lesions not classified into any of the above categories. Types 1a and 1b are considered angioectasias. Types 2a and 2b are Dieulafoy's lesions. Type 3 represents an arteriovenous malformation. Type 4 is unclassifiable. Three endoscopists independently reviewed images and video to classify 102 vascular lesions into the above types. The rate of concordance among the 3 endoscopists was calculated. Eighty-four lesions (82%) were classified into the same type by all of 3 endoscopists. The mean kappa value (standard deviation) for the concordance was 0.72 +/- 0.07, which confirmed substantial interobserver concordance. This classification is applicable only to endoscopic findings. It was desirable to correlate the histopathologic findings with endoscopic observations. This classification will be useful for selecting the hemostatic procedure and outcome studies.
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                Author and article information

                Journal
                Endosc Int Open
                Endosc Int Open
                10.1055/s-00025476
                Endoscopy International Open
                © Georg Thieme Verlag KG (Stuttgart · New York )
                2364-3722
                2196-9736
                March 2019
                28 February 2019
                : 7
                : 3
                : E372-E379
                Affiliations
                [ 1 ]Sorbonne Université & Department of Hepatogastroenterology, APHP, Saint Antoine Hospital, Paris, France
                [ 2 ]Drexel University, College of Arts & Sciences, Philadelphia, Pennsylvania, United States
                [ 3 ]Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
                [ 4 ]Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
                [ 5 ]Department of Gastrointestinal Endoscopy, Brest Teaching Hospital, Brest, France
                [ 6 ]Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
                [ 7 ]Department of Gastroenterology – NHC, Pamplona, Spain
                [ 8 ]Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
                [ 9 ]Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
                [10 ]Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
                [11 ]Gastroenterology Unit, Valduce Hospital, Como, Italy
                [12 ]Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
                [13 ]Gastroenterology & Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
                Author notes
                Corresponding author Leenhardt Romain Hopital Saint-Antoine – Gastroenterology and Endoscopic Department 184 Rue du Faubourg Saint-AntoineParis 75012France+0033149282000 romain.leenhardt@ 123456gmail.com
                Article
                10.1055/a-0761-9742
                6395173
                30834297
                2b4d6a47-1911-4f65-a94b-6e7622a65c65

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 07 May 2018
                : 09 August 2018
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