Forewords
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Forewords
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The Minimal Standard Terminology for Digestive Endoscopy is the achievement of a cooperative work initiated by the European Society for Gastrointestinal Endoscopy (ESGE) in 1990. A group of experts has selected terms to be introduced in the lexicon, on the basis of their endoscopic experience, with the aim of providing a comprehensive list of terms. From 1993, a close cooperation has been established with the American Society for Gastrointestinal Endoscopy (ASGE).
After release of the first version of the Minimal Standard Terminology for Digestive Endoscopy in 1995 (1), prospective testing trials were undertaken in Europe in the Gaster project, funded by the European Commission DG XIII and in the USA, in a NIH-granted project. Results of these testings are summarized in the text here following and have allowed the release of the current Version 2.0 of the Minimal Standard Terminology for Digestive Endoscopy in 2000 (2).
In this publication, the reader will find the Minimal Standard Terminology for Digestive Endoscopy, Version 2.0, followed by a complete set of definitions of all terms, attributes and attribute values that it contains. The definitions have been prepared by a group of experts of ESGE and ASGE, in the frame of the OMED Committee for Terminology and Standardization. The intent of the definitions is to indicate the user with the meaning of the terms and attributes as they should be used for generating an endoscopic report.
The format of the tables has then been reviewed by M. Delvaux and the definitions somewhat homogenized between the tables of the various organs, as they were prepared by separate authors.
Sections and Tables tables are numbered likely alike in the first and second parts, so that the reader will easily find the definition of a term appearing in a table of Part I, in the corresponding table of Part II. At the end of the book, an Index contains references linking each term to the tables containing it in Part II and the text of the Introduction. All tables should at the end display an "Other" term that is not appearing in the present tables, as it is a mandatory and recurrent term for description of unusual findings or other observation that are not listed in the tables.
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FOREWORD by the President of ESGE
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It is a pleasure to recommend this volume to world endoscopy. The concept underlying Minimal Standard Terminology (MST) is that endoscopic appearances can be described concisely and reproduced using a limited vocabulary. The lexicon has been accepted by the three major world zones and with appropriate software it will be possible to write a report in one language using MST that can be immediately translated into another one. It means that the appearances seen in one country can be described in terms accepted in all parts of the world making endoscopy reporting truly international.
Our thanks go to all of those who have worked so hard to bring this project to fruition but especially to Professor Zdenek Maratka, on whose standardized vocabulary it is based. We thank also Professor Massimo Crespi who has championed the project over many years with the able assistance of Dr Michel Delvaux who has chaired the OMED Committee. Our gratitude must also go particularly to the American and Japanese contingents who were prepared to support this European initiative so that it is now a world project which will be owned and maintained by OMED, the World Organization for Endoscopy.
In the years to come it will be necessary to modify the terminology as newer concepts and appearances in endoscopy are recognised. We look forward to seeing the system incorporated into software systems designed to report endoscopy procedures and to linking it with quality assurance initiatives.
This has been a triumph for international co-operation and I wish this volume and its successors every success.
Professor Anthony T R Axon, MD, FRCP
President of the European Society of Gastrointestinal Endoscopy
Professor of Gastroenterology, Department of Gastroenterology,
Room 190A Clarendon Wing, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK
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FOREWORD by the President of ASGE
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Endoscopy has provided a remarkable window into the GI tract, unveiling a new world of findings - both normal and abnormal. Over the years, there has been general agreement on the structure and key elements which should be included in an endoscopic report (Gastrointestinal Endoscopy 2000; 52: 827-830). How-ever, the development of descriptive terms for endoscopic findings has been chaotic. Descriptive terms have evolved over many years in the context of typ-ical apprenticeship type learning. The young student learned from the master, who created terms as new findings were encountered. Over the years, a Tower of Babel for endoscopic terminology emerged, which made it very difficult to exchange meaningful information. Terms and attributes were not standardized.
The ideal medical report should be held to the following standard: if two obser-vers see the same finding, their descriptions should be similar enough so that a reader of both reports would reach the same conclusion. To meet this standard the following requirements should be satisfied:
The terminology must be clear to all readers, so that a description cannot be subject to misinterpretation. Therefore common definitions of terms are critical
Each descriptor should include all of the relevant attributes of that finding - this may include size, color, number, appearance, shape, or anatomic location.
In endoscopy, there are many opportunities for vague reporting. For example, what is the meaning of the term: esophagitis? Although we all know that this means "inflammation of the esophagus" this term alone provides no clue about the severity or the extent of the pathology. What about the term: ulcer? Helpful descriptors might include anatomic location, size, and stigmata of bleeding.
Over the past decade, experts from the around the world have struggled to create a common language for endoscopic reporting, now known as the "Minimum Standard Terminology (MST) for Digestive Endoscopy" The international experts who convened regularly to assemble and validate this incredible work have been passionate about their task. The American Society for Gastrointestinal Endoscopy (ASGE) has proudly supported this important work in many ways. ASGE participated actively in the process or reviewing and validating the version 2.0 of MST. The outcome is a standard foundation for endoscopic reporting that can be used in any reporting system.
Why is a standardized language for endoscopy so essential? One of our most important tasks as physicians is to work towards continuous quality improve-ment of our clinical practice. We need to be critical thinkers - asking questions about why we do, what we do. To measure effectiveness of endoscopy, we must be able to analyze data from clinical practice settings. The advent of computer-ized endoscopic reporting systems facilitates this endeavor. Clinicians can easily access data from their practice to document quality of care, and investigators can utilize data to measure endoscopic outcomes - but only if reporting is standard-ized. The MST provides the essential foundation for achieving excellence in endoscopic practice.
We must remember that the development of any lexicon is an iterative process. The MST is best viewed as a living, breathing document, which will continue to change. New terms and descriptors will need to be added. The MST provides an invaluable structure for this growth process. As President of ASGE, I am pleased to endorse this important advance in endoscopic reporting.
Portland, VA, May 2002 David Lieberman MD, President, American Society for Gastrointestinal Endsocopy
Professor of Medicine
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FOREWORD by the President of JGES
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This book presents the Minimal Standard Terminology (MST), version 2.0 with definitions of terms for digestive endoscopy. Though this terminology is originally intended as a tool for computer generation of endoscopy report, it has given a firm basis for globally acceptable databases. Standardization of vocabulary means, to some extent, a restriction to the freedom of speech, but it warrants structured, standardized endoscopy report without loss of essential, fundamental information. It may not allow fancy, artistic description, but guarantees internationally understandable endoscopy report.
I know there is a reluctance to accept it among some Japanese endoscopists, but MST has scored a high satisfaction rate, more than 95 %, in the prospective testing. If the endoscopists get used to the structure and vocabulary of this terminology, it becomes a useful tool for endoscopy reporting. Please don't forget that it is a standard terminology; don't forget it is a minimal terminology. It is meant to be a practical tool for computer-generated endoscopy report. It is not designed for any specific research. It is not designed for discovery of a new finding. Once the result of those research activities comes to be generally accepted, it will certainly be incorporated into this MST. Terminology is a living thing. It keeps constant evolution. For this kind of progress and change, version control has been well discussed in the committee meetings. MST can grow and can undergo metamorphosis, if required.
This MST is a fruit of global cooperation among endoscopists. Dr. Melvin Schapiro and I, both representing American Society for Gastrointestinal Endoscopy (ASGE) and Japan Gastroenterological Endoscopy Society (JGES), respectively, have participated in this fancy enterprise originally proposed by the European Society of Gastrointestinal Endoscopy (ESGE) from the very beginning in 1990. We have now come so far as to publish the 2nd version. The readers will notice that this MST is in constant renewal, if they compare the past versions of the terminology. Japanese Edition of MST version 2.0 is already on the homepage of JGES (URL: http://www.jges.net).
Towards a global integration of endoscopy (which happens to be the slogan of my 63rd Congress of Japan Gastroenterological Endoscopy Society), MST is a powerful tool. It can bridge the language barriers. It can help modernize the endoscopy suits: Endoscopy report will come to be made by computer, not by handwriting. Computer-generated endoscopy reports form at the same time the ground for a common database around the world. I recommend a wide use of MST among Japanese endoscopists.
Prof. Masayuki A. Fujino, M.D., Ph.D.
President of the 63rd Congress of Japan Gastroenterological Endoscopy Society,
Chairman, First Department of Medicine, Yamanashi Medical University
Tamaho, Nakakoma-gun, Yamanashi, 409-3898 Japan
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PREFACE by the President of OMED
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The project of creation of a common international language to define endoscopic findings was idealised by Zdenek Maratka as a result of a round-table on Endoscopic Terminology presided by S.Tanaka and moderated by Z. Maratka during the World Congress of Gastroenterology held in Madrid in 1978, which I had the pleasure to attend.
In the following years, this project gained strength as one of the goals of OMED past Presidents. Also, with the help of Mr. Franz Reuter from Normed-Verlag, we have seen English, Spanish, Portuguese, French, Italian, German, Greek, Czech, Chinese, Russian and Japanese editions of "OMED ENDOSCOPIC TERMINOLOGY".
Considering the incredibly fast development of computerisation in endoscopy, a common endoscopic nomenclature became imperative for all those involved in endoscopy - including referring doctors - as well as in scientific studies in which endoscopy is used as the gold standard. Therefore the European Society for Gastrointestinal Endoscopy launched in 1990 a working party to propose a list of terms that would standardize the language for the various parts of the endoscopic report. The American and Japanese societies for Gastrointestinal Endoscopy joined the effort and it will now be continued in the frame of OMED. The efforts of several experts from these societies resulted in the "Minimal Standard Terminology for Digestive Endoscopy".
It is with proud that I see the edition of this "Minimal Standard Terminology for Digestive Endoscopy" in an attractive book with definitions of the terms and reference images. It now becomes the official OMED terminology for data processing in endoscopy. It is the result of the hard and tenacious work of one of the most active OMED committees: the Terminology and Data Processing Committee under the command of Michel Delvaux. This book matches with one of my major tasks as President of OMED which is the dissemination of a common international endoscopy language!
Rio de Janeiro, February 2002
Glaciomar Machado
President - OMED
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