Background
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.
Patients and Methods
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.
Results
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.
Limitations
This classification is applicable only to endoscopic findings. It was desirable to
correlate the histopathologic findings with endoscopic observations.
Conclusions
This classification will be useful for selecting the hemostatic procedure and outcome
studies.
Abbreviations:
APC (argon plasma coagulation), AVM (arteriovenous malformation), DBE (double-balloon endoscopy), OGIB (obscure GI bleeding)To read this article in full you will need to make a payment
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References
- Localized arteriovenous malformation of the jejunum.Arch Pathol Lab Med. 1994; 118: 181-183
- Dieulafoy's lesion.Gastrointest Endosc. 2003; 58: 236-243
Organization Mondiale d'Endoscopie Digestive (OMED). Minimal standard terminology 2.0. Available at: http://www.omed.org/index.php/resources/re_mst/. Accessed January 21, 2007.
- How good is that agreement.Epidemiology. 1996; 7 ([letter to editor]?): 561
Article info
Publication history
Accepted:
August 1,
2007
Received:
January 30,
2007
Tochigi, JapanFootnotes
See CME section; p. 117.
Identification
Copyright
© 2008 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
