Endoscopy 2022; 54(S 01): S34-S35
DOI: 10.1055/s-0042-1744629
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NOMENCLATURE AND SEMANTIC DESCRIPTION OF ATROPHIC LESIONS IN SMALL BOWEL CAPSULE ENDOSCOPY: AN INTERNATIONAL DELPHI CONSENSUS STATEMENT

L. Elli
1   Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milano, Italy
,
B. Marinoni
2   Università degli Studi di Milano, Post Graduate Specialization in Gastrointestinal Diseases, Milano, Italy
,
P. Baltes
3   Bethesda Krankenhaus Bergedorf, Hamburg, Germany
,
H. Beaumont
4   Amsterdam Universitair Medische Centra, Amsterdam, Netherlands
,
C. Bojarski
5   Charité – Universitätsmedizin Berlin, Berlino, Germany
,
F. Branchi
5   Charité – Universitätsmedizin Berlin, Berlino, Germany
,
M. Bruno
6   “Città della Salute e della Scienza” Hospital, Turin, Italy
,
J. Buchkremer
5   Charité – Universitätsmedizin Berlin, Berlino, Germany
,
S. Cadoni
7   CTO Hospital, Iglesias, Italy
,
F. Cavallaro
1   Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milano, Italy
,
S. Chetcuti Zammit
8   Royal Hallamshire Hospital, Sheffield, United Kingdom
,
X. Dray
9   Sorbonne Université, Paris, France
,
R. Eliakim
10   Tel Aviv University, Tel Aviv, Israel
,
P. Ellul
11   Paris University, Paris, France
,
I. Fernandez Urien
12   Complejo Hospitalario de Navarra, Pamplona, Spain
,
M. Keuchel
13   Academic Teaching Hospital of the University of Hamburg, Hamburg, Germany
,
S. Khater
14   Hôpital Européen Georges Pompidou, Paris, France
,
U. Kopylov
10   Tel Aviv University, Tel Aviv, Israel
,
A. Koulaouzidis
15   Pomeranian Medical University, Szczecin, Poland
,
R. Leenhardt
9   Sorbonne Université, Paris, France
,
C. Marmo
16   IRCCS Fondazione Policlinico Gemelli, Rome, Italy
,
D. McNamara
17   Tallaght University Hospital, Dublin, Ireland
,
A. Mussetto
18   Santa Maria delle Croci Hospital, Ravenna, Italy
,
A. Nemeth
19   Lund University, Malmö, Sweden
,
E.P. Cuadrado Robles
20   Morales Meseguer Hospital, Murcia, Spain
,
G. Perrod
11   Paris University, Paris, France
,
G. Rahmi
11   Paris University, Paris, France
,
M.E. Riccioni
21   Università Cattolica del Sacro Cuore, Rome, Italy
,
A. Robertson
22   Western General Hospital, Edinburgh, United Kingdom
,
E. Rondonotti
23   Valduce Hospital, Como, Italy
,
J.C. Saurin
24   CNRS, Villeurbanne, France
,
R. Sidhu
8   Royal Hallamshire Hospital, Sheffield, United Kingdom
,
C. Spada
25   Fondazione Poliambulanza, Brescia, Italy
,
E. Toth
15   Pomeranian Medical University, Szczecin, Poland
,
G.E. Tontini
26   Università degli Studi di Milano, Department of Pathophysiology and Organ Transplantation, Milano, Italy
,
K. Triantafyllou
27   “Attikon” University General Hospital, Athens, Greece
,
G.W. Johansson
28   Karolinska University Hospital Ringgold standard institution, Stockholm, Sweden
,
A. Rimondi
2   Università degli Studi di Milano, Post Graduate Specialization in Gastrointestinal Diseases, Milano, Italy
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    Aims Coeliac disease (CD) and serology negative villous atrophy represent growing indications for small bowel capsule endoscopy (SBCE). Uniformity in reporting features of small bowel atrophy in SBCE is missing and the recognition of atrophic signs is variable. In this study we aimed to establish an international Consensus regarding nomenclature and descriptions of the main atrophic lesions.

    Methods A Delphi Method Consensus was employed to reach the agreement in a panel of experts in SBCE. The nomenclatures and descriptions of the atrophic lesions were decided in a core group of 10 experts via a question and feedback mechanism. After achieving consensus, four images for each lesion were chosen in a large database of SBCE and agreement on the correspondence between the picture and the definition was evaluated with the same method in a broadened group of 36 experts.

    Results Four atrophic lesions were identified: Mosaicism, Scalloping, Folds reduction and Granular mucosa. The core group succeeded in reaching the agreement on the nomenclature and description of these items ([Table 1]). The consensus in matching the agreed definitions to the proposed set of images was met for Mosaicism (88.9%-1stround), Scalloping (97.2%-1stround) and Folds Reduction (94.4%-1stround), whereas Granular Mucosa failed to achieve a consensus (75.0%-3rdround). Operator expertise in CD SBCE (i.e. upper quartile in numbers of dedicated CD capsules per year) did not influence the identification of atrophic signs.

    Table 1

    Nomenclature and Description

    Agreement in core group (total no. 10)

    Number of rounds

    Mosaicism: loss of villous structure with the presence of non-ulcerated, orthogonally converging fissures of the small bowel mucosa

    9 out of 10 (90%)

    2

    Scalloping: presence of multiple incisures on the edge of the small bowel folds (cogwheel appearance)

    10 out of 10 (100%)

    2

    Folds Reduction: flattening of the mucosa with reduction of the folds (<2 field view) in terms of both height and number

    10 out of 10 (100%)

    2

    Granular Mucosa: mucosal surface characterized by multiple small nodules, rough villous architecture and edema of the villi

    9 out of 10 (90%)

    3

    Conclusions For the first time ever, a consensus among 36 experts of SBCE on the most common atrophic lesions frequently found in CD and related conditions was set.


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    Publication History

    Article published online:
    14 April 2022

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