title: Endoscopic classification of vascular lesions of the small intestine (with videos).
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  This classification is applicable only to endoscopic findings. It was desirable to correlate the histopathologic findings with endoscopic observations.
  
  
  CONCLUSIONS
  This classification will be useful for selecting the hemostatic procedure and outcome studies.
authors.affiliation: Tochigi, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyata
authors.forename: Michiko
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Arashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D016888:Angiodysplasia / Q000175:diagnosis*; D001165:Arteriovenous Malformations / Q000175:diagnosis; D004108:Dilatation, Pathologic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow