Endoscopic Diagnosis in Gastroenterology,
edited by Z. Maratka.
Normed Verlag Inc, 291 Audubon Road, Englewood, New Jersey, USA 07631. ISBN 3-89199-064-2; US$40
and
NORMEDIA Gastro,
Multimedia Endoscopy CD-ROM, Version 2.0
ed. By Z. Maratka and J. R. Armengol Miro, ISBN 3-89199-066-9, US$ 237.
The premise of this manual is that endoscopists must be able to communicate consistently and accurately their endoscopic evaluations to other colleagues. For this occur, standardized terminology is required. Describing the endoscopic finding is the first step in the assessment of a patient, before interpretation and final diagnosis (which is usually based on histological or cytological examination). To arrange terminology, the editors have divided the manual into 11 different sections: fundamental terms and definitions; esophagoscopy; gastroscopy; duodenoscopy; postoperative stomach and duodenum; rectocolonoscopy; laparoscopy; electroscopic retrograde cholangiopancreatography (ERCP); endoscopic ultrasonography; other diagnostic procedures; and endoscopic therapy.
The first six sections are subsequently divided into nine subheadings, including lumen, contents, wall, peristalsis, mucosa, hemorrage, flat changes, protrusions, and depressed and excavated lesions. Either the manual (illustrations included) or the compact disc can be used for reviewing endoscopic terminology. Ideally, to obtain the most information in terminology, the compact disc and the text should be used in combination. The advantage of the compact disc is that lectures can be created, illustrations downloaded, and modifications and updates easily handled. Furthermore, the compact disc has several additional sections (histology, video endoscopy) that are not present in the manual.
COMMENTARY
The key to understanding and using this manual appropriately is ensuring that the physician knows why the manual was commissioned. This text and compact disc are not designed as an endoscopic atlas with an exhausting review of endoscopic findings. If the viewing endoscopist expects to reviews endoscopic findings and use this text as a reference for rare endoscopic events or as a " how to do " manual, he or she will be disappointed. The compact disc and the manual are designed as a terminology reference for endoscopists to become consistent in their descriptions of normal and abnormal endoscopic findings. The images (in the manual and the compact disc) are designed simply to supplement the investigator to ensure in his or her desire that the visual image is correctly described.
In an effort to develop a consistent, uniform language in endoscopy, the authors have clearly invested a great deal of energy and time. This latest edition (complete with compact disc) has enabled widespread dissemination. The compact disc and manual can be of benefit, especially to trainees who should be reviewing their endoscopic findings and descriptors of it on a regular basis to ensure that they are consistent and accurate. Rather than being told by a "mature" endoscopist (who, in fact, may use incorrect terminology) what to dictate, it would be ideal if every training endoscopist review this compact disc and/or the manual on a regular basis to ensure precision dictations and reduce the possibility of interobserver variations. Furthermore, it is a refreshing change, rather than reading a typical journal article, to review images and terminology casually to enhance one's knowledge.
Description of endoscopy can then be made an art (combined with science). With corrections of both reports, the attending staff and the trainee can improve their endoscopic description.
Another advantage of the compact disc format is the added benefit of the ability to annotate either images or text. This enable the user to develop an individualized version that will adapt to one's own needs. Furthermore, images can be copied and downloaded to other programs (ie, PowerPoint) to be used for lectures or a personal library. Endoscopic images (when copied and transferred) appear with identifying information ( copyright insignia and "Normed") on the image. The images are of excellent clarity, and the "downloading" process has been simplified for users with minimal computer skills.
Despite the strength of this work, there are several weaknesses. The absence of certain images and the lack of completeness of an endoscopic atlas can be explained by the primary goal of the manual as a terminology text. The organization of the compact disc into slightly different groups than the manual is at first somewhat cumbersome, but with continued use, soon becomes second nature. The use of multiple subheadings under each chapter aids in organization, with the drawback of occasionally giving the impression of working through a dictionary. Certain sections include video demonstrations, often demonstrating endoscopic techniques and advanced endoscopic procedures. It is unclear why a text with terminology as the primary goal needs endoscopic video clips, but likely it makes the "package " more marketable by appealing to the procedure-orientated audience. Unfortunately, some of the videos demonstrate techniques (ie, " a zipper-sphincterotomy in a ERCP video") that in most training centres in North America would be discouraged or even considered dangerous. Perhaps the absence of any North American author has had an impact on the techniques and has inhibited the manual from gaining the global recognition that it rightly deserves. In summary, the value of this work by lies in its primary purpose of providing a terminology library for endoscopy. This purpose of the manual is clearly met with outstanding completeness. This text should be considered a reference for trainees and gastroenterologists who wish to develop consistency and accuracy with regard to endoscopic terminology.
To order for more information contact:
Normed Verlag Inc, 291 Audubon Road, Englewood, New Jersey, USA, 07631, fax 201-569-5386
SUGGESTED READING
Crespi M, Delvaux M, Venable C, Zwiebel F, Minimal standard terminology for a computerized endoscopic database. AM J Gastroenterol 1996;91:91-216.
Maratka Z: Terminology, definitions and diagnostic criteria in digestive endoscopy. With the collaboration of the members of the Terminology Committee of the World Society Digestive Endoscopy/OMED. Scand J Gastroenterol 1984;103:1-74.
Maratka Z. Terminology of endoscopic findings in teaching and postgraduate education in gastroenterology. Acta endoscopia 1991;21:535-8.
Maratka Z. The role of terminology in medical education and training. Scand J Gastroenetrol 1991;26:30-1
Maratka Z. Toward a better endoscopic terminology. Gastrointest Endosc 1983;29:136-7. Maratka Z, Schapiro M, Terminology and ist application to computer-aided data processing in digestive endoscopy. J Clin Gastroenterol 1990;12:130-1.
Robert Enns MD FRCPC
St. Paul's Hospital University of British Columbia
Vancouver, British Columbia
