Nomenclature and Definition of Atrophic Lesions in Small Bowel Capsule Endoscopy: A Delphi Consensus Statement of the International CApsule endoscopy REsearch (I-CARE) Group
Luca Elli, Beatrice Marinoni, Reena Sidhu, Christian Bojarski, Federica Branchi, Gian Eugenio Tontini, Stefania Chetcuti Zammit, Shérine Khater, Rami Eliakim, Emanuele Rondonotti, J.-C. Saurin, Mauro Bruno, Juliane Buchkremer, Sergio Cadoni, Flaminia Cavallaro, Xavier Dray, Pierre Ellul, Ignacio Fernández Urién, Martin Keuchel, Uri Kopylov, Anastasios Koulaouzidis, Romain Leenhardt, Peter Baltes, Hanneke Beaumont, C. Marmo, Deirdre McNamara, Alessandro Mussetto, Artúr Németh, Enrique Pérez‐Cuadrado‐Robles, Guillame Perrod, Gabriel Rahmi, Maria Elena Riccioni, Alexander Robertson, Cristiano Spada, Ervin Tóth, Κonstantinos Τriantafyllou, Gabriele Wurm Johansson, Alessandro Rimondi
Abstract
(1) Background: Villous atrophy is an indication for small bowel capsule endoscopy (SBCE). However, SBCE findings are not described uniformly and atrophic features are sometimes not recognized; (2) Methods: The Delphi technique was employed to reach agreement among a panel of SBCE experts. The nomenclature and definitions of SBCE lesions suggesting the presence of atrophy were decided in a core group of 10 experts. Four images of each lesion were chosen from a large SBCE database and agreement on the correspondence between the picture and the definition was evaluated using the Delphi method in a broadened group of 36 experts. All images corresponded to histologically proven mucosal atrophy; (3) Results: Four types of atrophic lesions were identified: mosaicism, scalloping, folds reduction, and granular mucosa. The core group succeeded in reaching agreement on the nomenclature and the descriptions of these items. Consensus in matching the agreed definitions for the proposed set of images was met for mosaicism (88.9% in the first round), scalloping (97.2% in the first round), and folds reduction (94.4% in the first round), but granular mucosa failed to achieve consensus (75.0% in the third round); (4) Conclusions: Consensus among SBCE experts on atrophic lesions was met for the first time. Mosaicism, scalloping, and folds reduction are the most reliable signs, while the description of granular mucosa remains uncertain.