Romain Leenhardt1, Anthony Buisson2, Arnaud Bourreille3, Philippe Marteau1, Anastasios Koulaouzidis4, Cynthia Li1,5, Martin Keuchel6, Emmanuele Rondonotti7, Ervin Toth8, John N Plevris4, Rami Eliakim9, Bruno Rosa10, Konstantinos Triantafyllou11, Luca Elli12, Gabriele Wurm Johansson8, Simon Panter13, Pierre Ellul14, Enrique Pérez-Cuadrado Robles15,16, Deirdre McNamara17, Hanneke Beaumont18, Cristiano Spada19, Flaminia Cavallaro20, Franck Cholet21, Ignacio Fernandez-Urien Sainz22, Uri Kopylov9, Mark E McAlindon23, Artur Németh8, Gian Eugenio Tontini24, Diana E Yung4, Yaron Niv25, Gabriel Rahmi16, Jean-Christophe Saurin26, Xavier Dray1. 1. Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, AP-HP, Paris, France. 2. Dept. of Gastroenterology, CHU Estaing Clermont-Ferrand, Clermont-ferrand, France. 3. Institut des Maladies de l'Appareil Digestif (IMAD), Dept of Gastroenterology, CHU Nantes, University of Nantes, Nantes, France. 4. Centre For Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 5. College of Arts & Sciences, Drexel University, Philadelphia, USA. 6. Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Hamburg, Germany. 7. Gastroenterology Unit, Valduce Hospital, Como, Italy. 8. Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden. 9. Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 10. Departamento de Gastroenterologia, Universidade do Minho, Hospital Senhora da Oliveira, Guimarães, Portugal. 11. Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece. 12. Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca Granda, Milano, Italy. 13. Gastroenterology, South Tyneside Hospital, South Shields, United Kingdom. 14. Department of Medicine, Mater Dei Hospital, Msida, Malta. 15. Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium. 16. Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European hospital, Paris, France. 17. Trinity Academic Gastroenterology Group, Departement of Clinical Medicine, Tallaght Hospital, Trinity College Dublin, Ireland. 18. Department of Gastroenterology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 19. Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Roma, Italia. 20. Gastroenterology and Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 21. Endoscopy unit, CHU La Cavale Blanche, Brest, France. 22. Gastroenterology, Hospital de Navarra, Pamplona, Spain. 23. Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. 24. Department of Pathophysiology and Transplantation, University of Milan - Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 25. Rabin Medical Center, Dept. of Gastroenterology, Petach Tikva, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 26. Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France.
Abstract
BACKGROUND: In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE. OBJECTIVE: Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions. METHODS: An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories. RESULTS: A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: aphthoid erosion, deep ulceration, superficial ulceration, stenosis, edema, hyperemia and denudation. CONCLUSION: Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.
BACKGROUND: In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE. OBJECTIVE: Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions. METHODS: An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories. RESULTS: A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: aphthoid erosion, deep ulceration, superficial ulceration, stenosis, edema, hyperemia and denudation. CONCLUSION: Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.
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