Yano Tomonori, Yamamoto Hironori, Sunada Keijiro, Miyata Tomohiko, Iwamoto Michiko, Hayashi Yoshikazu, Arashiro Masayuki, Sugano Kentaro
Tochigi, Japan.
Gastrointest Endosc. 2008 Jan;67(1):169-72. doi: 10.1016/j.gie.2007.08.005.
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.
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.
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.
This classification is applicable only to endoscopic findings. It was desirable to correlate the histopathologic findings with endoscopic observations.
This classification will be useful for selecting the hemostatic procedure and outcome studies.
内镜检查发现的小肠血管病变外观各异。血管扩张是一种静脉病变，需要烧灼治疗；Dieulafoy病和动静脉畸形可能导致动脉出血，需要夹闭或开腹手术。为选择合适的治疗方法，有必要区分静脉和动脉病变。
我们将这些病变分为以下6组：1a型，点状红斑（<1mm），有或无渗血；1b型，斑片状红斑（数毫米），有或无渗血；2a型，点状病变（<1mm），有搏动性出血；2b型，搏动性红色隆起，无周围静脉扩张；3型，搏动性红色隆起，有周围静脉扩张；4型，未归入上述任何类别的其他病变。1a型和1b型被认为是血管扩张。2a型和2b型是Dieulafoy病。3型代表动静脉畸形。4型无法分类。三位内镜医师独立查看图像和视频，将102处血管病变分为上述类型。计算三位内镜医师之间的一致性率。
84处病变（82%）被三位内镜医师均分类为同一类型。一致性的平均kappa值（标准差）为0.72±0.07，证实观察者间有高度一致性。
这种分类仅适用于内镜检查结果。将组织病理学结果与内镜观察结果相关联是可取的。
这种分类将有助于选择止血程序和进行结果研究。
