Document Detail

Endoscopic classification of vascular lesions of the small intestine (with videos).
MedLine Citation:
PMID:  18155439     Owner:  NLM     Status:  MEDLINE    
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.
Tomonori Yano; Hironori Yamamoto; Keijiro Sunada; Tomohiko Miyata; Michiko Iwamoto; Yoshikazu Hayashi; Masayuki Arashiro; Kentaro Sugano
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  67     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-24     Completed Date:  2008-03-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  169-72     Citation Subset:  IM    
Tochigi, Japan.
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MeSH Terms
Angiodysplasia / diagnosis*
Arteriovenous Malformations / diagnosis
Dilatation, Pathologic
Endoscopy, Gastrointestinal*
Intestine, Small / blood supply
Middle Aged
Pulsatile Flow

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