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[Last update 10.May 2002]
2.0 序文（Introduction）
Since computers became more readily available and relatively inexpensive,
there has been increasing interest in their use for recording the findings
at endoscopy. The advantages are that it is possible to search any database
created, perform statistical analysis, and avoid the need for hand-written
or typed reports. Around the world, a considerable number of endoscopy
record systems have been developed but there has been no standardization
of the terminology used. As a result, a golden opportunity has been lost
for sharing and comparing data collected from different centers.
Following a meeting on "Computers in Endoscopy" organized by
Pr. M. Classen in Munich in 1991, it became apparent that this important
problem needed resolution. The European Society for Gastrointestinal Endoscopy
decided to resolve the issues. A Committee was established under the chairmanship
of Pr. M. Crespi and included a number of experts from Belgium, France,
Germany, Hungary, Italy, Spain and the United Kingdom. Dr. Maratka from
Czech Republic was invited to join the Committee because of the work that
he had already done on endoscopic terminology for the World Organization
for Digestive Endoscopy (OMED). At an early stage, it was felt important
that the other World Zones be represented and representatives from the
USA and Japan were added to the Committee. Additionally, the three major
endoscope manufacturers (Fujinon, Olympus and Pentax) and the publisher
Normed-Verlag were invited to join the committee as it was imperative that
industry should be involved in this work as they were developing their
own systems and compatibility between these was regarded as vital if the
opportunities for sharing data were to be optimized. It was also important
that these companies be involved in discussing other aspects, such as image
capture, storage and transfer.
Between 1992 and 1993, a series of meetings of this Committee were held,
concluding with a joint meeting of the ESGE group and the Computer Committee
of the American Society for Gastrointestinal Endoscopy (ASGE). At this
time, the work was reviewed and modified and the Committee was constituted
as the Working Party for this report for the World Congresses of Gastroenterology
and Digestive Endoscopy.
The list of terms proposed has drawn heavily upon the original and detailed
work performed by the OMED committee under the chairmanship and guidance
of Pr. Z. Maratka. When published in full, the terms selected will be preceded,
when applicable, by the OMED code number, as published in "Terminology,
Definitions and Diagnostic Criteria in Digestive Endoscopy; 3rd Edition.
This will provide a reference for users unfamiliar with the words employed.
This reference provides a definition of the term together with its language
equivalents, if English is not the user's natural language. Currently there
are editions of this book in French, German, Italian and Spanish, and several
other languages.
In order to obtain Committee consensus, it was necessary to include a few
"terms" that were not originally included in the OMED classification.
This was because these words were in such common use that the Committee
felt that they had to be included if the database created was to prove
acceptable to an average user. Similarly, the list of "attributes"
attached to any term to provide greater detail was restricted to those
that were most commonly employed. As a result, the amount of detail provided
may prove insufficient for some users of the terminology, particularly
those wishing to record considerable detail for "research" purposes.
However, it was agreed that any endoscopist wishing to record extra-detail
could do so, providing the computer system developed contains the "minimal
terminology". For this reason, only terms commonly used to describe
a lesion have been included. Unreliable attributes, such as distance from
the teeth for a gastric lesion, and from the anal margin for a colonic
lesion located above the rectum, have not been included.
MST version 1.0 formed the basis for prospective testing of the Terminology
in Europe and the United States. This testing was funded by the European
Commission through the Gaster Project and the American Digestive Health
Foundation. The results of this prospective testing forms the basis for
modifications made to version 1.0 that are presented here. The changes
have been reviewed and accepted by the ESGE and ASGE Committees and constitute
the Minimal Standard Terminology version 2.0. Specific software was developed
for testing which allowed endoscopists in univeristy hospitals and private
practice to prospectively record endoscopic cases using the Minimal Standard
Terminology version 1.0In Europe, the software was designed to provide
the endoscopists with a translation into the main European languages (English,
French, German, Italian, Spanish) and the possibility of performing the
final analysis independent of the original language in which the cases
had been recorded.
2.1 構成（General organization）
The principles by which the list of terms is described on page 21. In the
same paragraph, is explained the structure of the terms, attributes and
attribute values.
2.2 問題のある用語をめぐる決定（Decisions on difficult terms.）
The Committee paid particular attention to which terms to include and which
to avoid because some lead to ambiguity, misuse or were considered to be
redundant. The selection of a term had to take into account the need for
a very precise descriptive word and the acceptability of these words amongst
physicians from different countries with different native languages. There
was also the problem of different, but closely related, words used more
commonly in one language than in another. This led to the selection of
terms based on English with some minor differences between Europe and the
United States. Translations of these terms in other languages should be
based on the official translations found within the OMED terminology.
2.2.1 狭窄（Stenosis）
A narrowed segment of the gut can be described in a number of ways: "narrowed",
"strictured", "stenosed", "compressed". All
of these terms have been grouped in the terminology under the generic term
"stenosis". The same term has been used to describe the narrowing
of a sphincter which either prevents the passage of the endoscope or requires
force to traverse it. Functional terms such as "spasm" have been
avoided because of their subjective nature. Once a stenosis has been described
it is qualified by attribute values: "extrinsic", "intrinsic
benign" or "intrinsic malignant", based on the probable
cause. In the case of an extrinsic compression, where actual stenosis of
the lumen does not occur, e.g. the aortic prominence, the term "stenosis"
should not be used.
2.2.2 発赤粘膜、発赤斑、うっ血性粘膜、充血（Red mucosal, erythema, congested
mucosa, hyperemia）
During prolonged discussions on which terms to include in the minimal standard
terminology, it became apparent that all of the above terms were used to
define roughly similar lesions or mucosal patterns. It was finally agreed
that it was only necessary to distinguish between an erythematous and a
congested mucosal appearance. Erythematous mucosa being defined as either
a focal or diffuse reddening of the mucosa without any other modification;
congested mucosa, on the other hand, being defined as a combination of
erythema with an edematous, swollen or friable mucosa. Due to the large
overlap between these terms, it was agreed that hyperemia was equivalent
to erythema and edematous was equivalent to congested mucosa. So these
words could be used as an alternative but not added simultaneously to the
number of terms used.
2.2.3 粘膜の硬化（Mucosal sclerosis）
This term is used to describe post-sclerotherapy mucosal and submucosal
changes that can occur in the esophagus after endoscopic sclerotherapy
of esophageal varices. Although the term "fibrosis" primarily
describes histological changes, it is so frequently used that it was accepted
as equivalent to sclerosis. Testing studies showed that mucosal sclerosis
was also used to describe the aspect of a sclerotic lower third of the
esophagus in the absence of any antecedent variceal therapy. To overcome
this dual meaning of the term, an attribute as been added to specify whether
it is spontaneous or post-therapeutic.
2.2.4 びらん、アフタ（Erosion, aphtha）
In the original OMED terminology, the term "erosion" had been
avoided because it was considered to be imprecise and required histological
confirmation; "aphtha" had, therefore, been the preferred term.
During extensive discussions, the Committee had come to the conclusion
that the term "erosion" was in such common usage in many languages
that it had to be included amongst the minimal standard. However, a strict
definition of this term is required. "Erosion" is defined as
a small superficial defect in a mucosa, of a white or yellow color, with
a flat edge. This may bleed, but the term should only be used when the
mucosa is clearly seen and is not covered by blood clot.
In the colon, it was decided to retain the term "aphtha", as
it was agreed that aphthae were identified more frequently in this area
and were a recognized diagnostic feature of "Crohn's disease".
In this context, aphthae are defined as yellow or white spots, surrounded
by a red halo and frequently with a spot in the center. Aphthae are frequently
seen within a congested or erythematous mucosa and are often multiple.
2.2.5 腫瘍、腫瘤（Tumor, mass）
In the original Committee recommendations, the word "tumor" was
used to describe any lesion which appears to be of a neoplastic nature
but without any attempt to say whether it is benign or malignant. It is
not used for small lesions such as granules, papules etc..., nor for other
protruding lesions such as polyps, varices or giant folds. The conjoint
ASGE review revealed difficulty with this term as, in the USA, a patient
might assume that a tumor is a malignant lesion. For this reason, it has
been agreed that the term "mass" could be used as an equivalent
term when needed.
2.2.6 血管拡張症（Angioectasia）
Both telangiectasia and angiodysplasia have been grouped under this generic
term. This is because there are no precise visible diagnostic criteria
which will allow one to distinguish between these two lesions. This term
can also be applied to congenital and acquired vascular malformations within
the mucosa of the gastrointestinal tract.
2.2.7 瘢痕（Scar）
The term "scar" is preferred to the term "fibrosis"
as the latter implies a histologically confirmed process. The cicatricial
aspect of the mucosa after healing of an ulcer or following a therapeutic
maneuver (e.g. injection sclerosis; laser photocoagulation) seems to fit
better with this word.
2.2.8 閉塞（Occlusion, obstruction.）
According to the definition contained in the OMED terminology, "obstruction"
means blockage of a tubular structure by an intraluminal obstacle (e.g.
foreign body) while "occlusion" implies complete closure of the
lumen by an intrinsic lesion of the wall (e.g. fibrosis from a healing
duodenal ulcer causing pyloric stenosis). Although obstruction and occlusion
can be either partial or complete, the use of these two terms was felt
to be confusing and created difficulties when translated into other languages.
It was, therefore, decided to restrict the use of the term "obstruction"
to 2 situations: (i) the presence of an exophytic tumor in a tubular organ;
(ii) the findings in the biliary tree and in pancreatic ducts at X-ray
examination during an ERCP. This term covers partial or complete hold-up
to the passage of contrast into a duct, whatever the cause of this obstruction
(e.g. stone, tumor, foreign body). In the case of obstruction of a tubular
organ, this obstruction would be described as partial or complete, depending
whether a lumen is present or not.
2.2.9 潰瘍形成性粘膜（Ulcerated mucosa.）
Endoscopists felt that there may be a conceptual distinction between ulcers
that are multiple and mucosa that was ulcerated. Testing indicated that
a term describing a diffusely ulcerated mucosa in one concept was frequently
used, both in the US and in Europe and it appeared that the endoscopists
using this term considered this global pattern of the mucosa as rather
typical of ulcerative colitis. Therefore, Ulcerated mucosa was introduced
in version 2.0. It is emphasized that this term should be used only in
the case of a diffusely ulcerated mucosa when the endoscopist distinguishes
this concept from "ulcers" that are multiple. However, it is
recognized that the use of this term needs to be evaluated in prospective
trials, in order to better define its meaning and whether it is a distinct
concept from the term "ulcer".
| 2.3 |
病変の部位についての合意事項（Location of Lesions: Principles and Consensus
Decisions.） |
2.3.1 総論（General principles.）
Although location of a lesion is a key point in any description of a term,
specifications such as distance from the teeth or anal verge could be imprecise
in certain organs or sites. It was, therefore decided that such "distance
specifications" should only be employed where the organ being examined
allows this to be relevant (e.g. esophagus at upper GI endoscopy and rectum
at colonoscopy).
In some cases, multiple recording of sites should be implemented, as far
as some multiple lesions need specification of the site for each of them
or when the precise location of a lesion needs the use of two terms (e.g.
in the stomach, a tumor growing on the "lesser curvature" of
the "antrum").
| 2.3.2 |
議論のある部位用語に関する決定
（Decisions on difficult locations.） |
Among the many locations defined in the terminology, there were some that
were only agreed after prolonged discussion. The arguments for these decisions
were as follows:
2.3.2.1 噴門、食道裂孔、下部食道括約筋、図を参照（Cardia, Hiatus, Lower
Esophageal Sphinc-ter.）
There are many terms that have been used to describe the area of the esophago-gastric
junction (Figure 1A). Although these can be carefully defined, they are
often assumed to be synonymous and are used incorrectly as a result. To
clarify this situation, it was decided to omit the term "lower esophageal
sphincter" from the list of locations within the esophagus section
as it is difficult to identify, being a functional entity, and cannot be
used as a fixed point for locating an individual lesion. However, this
term was included as a specific term within the category "Lumen",
to enable the user of a system to record its appearance (e.g. gaping or
hypertonic).
The "esophago-gastric junction" implies a transition from the
esophagus to the stomach but is usually used for the mucosal junction (Z-line).
It has, therefore, been avoided as a location, because it may be located
apart from the exact junction between the esophagus and the stomach.
"Hiatus" describes the orifice in the diaphragm which can be
difficult to identify and tends to cause difficulties when defining a hiatus
hernia. For these reasons, the term "cardia" was chosen to describe
the whole of this region. Following initial testing of the terminology,
it became apparent that this caused problems when describing a hiatus hernia.
Initially, it had been agreed that the size of any hernia present would
simply be recorded as "small" or "large". However,
many users wanted to describe the size of a hiatus hernia as the distance
between the Z-line and an anatomical reference defining the passage of
the diaphragm. Likewise, the length of a Barrett's esophagus was defined
as the distance between the transition from the esophageal mucosa to gastric
mucosa (Z line) and an anatomic reference for the end the smooth tube-like
esophagus. For this reason, the term "hiatal narrowing" was included
within the version 1.0 of the terminology. This would also allow better
specification of the length of a Barrett's esophagus and possibly of hiatus
hernia.
However, the testing of MST version 1.0 indicated that the location cardia
and the terms Z line and Hiatal narrowing were poorly undertsood by the
users. To clarify the description the following modifications were made:
・the position of the Z line (given in cm from incisors) could be specified
as an attribute of Normal, Hiatus Hernia and Barrett's Esophagus.
・Hiatal narrowing is used as a distance measure for Hiatus Hernia. This
anatomical reference, when combined with the distance measure for Z line,
should more precisely define the length of a Hiatus Hernia.
・Upper end of Gastric Folds is used as a distance measure for Barrett's
Esophagus. This change when combined with the distance measure for Z line
should more precisely define the length of a Barrett's Esophagus.
2.3.2.2 図を参照（Gastric Fundus, Body and Antrum.）
Fundus is used to describe the anatomical part of the stomach that lies
under the diaphragm on a barium meal examination. In the OMED terminology
the term "fundus" is regarded as confusing and the term "fornix"
has been preferred to describe the upper area of the stomach examined during
a reverse maneuver. In the recommended minimal standard terminology, the
term "fundus" has been used as it is so commonly employed that
it was felt undesirable to remove it.
The gastric body is defined as the area of the stomach above the angulus
which is usually lined by folded gastric mucosa. The antrum is defined
as the distal part of the stomach usually lined by flat mucosa.
2.3.2.3 胆道系、図を参照（Biliary Tree ）
A problem occurs in the description of the biliary tree. The anatomical
divisions "common hepatic duct" and "common bile duct"
within the extrahepatic duct are defined by the insertion of the cystic
duct. This division makes no allowance for the variability in this junction
and leads to considerable confusion when trying to identify the site of
a lesion within the extrahepatic duct. For this reason it was decided to
identify a site called the "main bile duct", which would encompass
both the common hepatic and common bile duct, locating any lesion as being
within the upper, middle or lower third of this duct (Figure 2).
The major intrahepatic ducts were identified as right and left hepatic
ducts from the junction at the porta hepatis and their first sub-division.
All other ducts within the liver are called intrahepatic ducts.
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