Thomas de Lange (Norway)
Interview with Professor Björn Rembacken (UK), former chair of the Documentation & Standardization Committee:
Tell us a bit about the activities of your committee: what are its main objectives?
It was over 30 years ago that Maratka et al. published the first systematic structure of terminology to describe lesions encountered at Endoscopy. Edition 2 and three refined this further and can be downloaded on the WEO website.
The original idea behind a common endoscopic reporting terminology was that findings could be discussed between endoscopy units even when situated on different continents. However, quality assurance (QA) has pushed for endoscopic reporting systems to include a common language to describe more than just findings. For example, a simple measurement such as “polyp detection rate” is of limited value without information on the patients. Were they old or young, male or female, were they symptomatic vs. surveillance patients, what was the average state of bowel cleansing ?
Other information has also become important in the continuous quality improvement of endoscopy. Endoscopists now expect their reporting system to provide feedback on data such as doses of analgesia and sedation used, depth of sedation, degree of patient discomfort, outcomes of therapeutic procedures etc.
In addition to quality assurance, clinicians nowadays expect findings to be described in language they understand such as the “Mayo activity score” of colitis or the “Rutgeert’s score” of relapsing Crohn’s disease etc.
What can members expect to gain or to learn when they join your committee?
Many endoscopic scales exist to describe for example, depth of sedation, level of patient comfort and the state of bowel cleansing etc. However, none of these have as yet been incorporated into a minimal standard reporting framework. The task of our committee is to bring the Standard Endoscopy Reporting terminology up to date and forward a recommendation which includes all information demanded by endoscopists quality assurance programmes and clinicians.
What interested you to join this committee/lead this activity?
As a full time endoscopists and quality assurance lead, I interact daily with my endoscopic reporting programme. To be part of a group aiming to bring about improvements in endoscopic reporting tools seemed like a worthwhile endeavour ! I am hoping that an online tool can be developed to allow the endoscopic community to give feedback on our proposals before final sign-off.
What do you see in the future for this activity/field?
Our challenge is to incorporate the many systems, currently in use, to describe pathology. Examples includes the Prague classification for Barrett’s, Sarin Classification of gastric varices, Forrest’s classification of peptic ulcers, Spigelman classification of duodenal polyps, Paris classification of lesion morphology, Kudo classification of crypt patterns, Rutgeerts score of postoperative Crohn’s disease etc. Many of these classification systems are useful, universally understood and underpin patient evaluation and research. Our MSR should now be expanded to include the classification systems which are most useful. My hope is that the WEO recommendation can become the standard configuration of all endoscopic reporting programmes regardless of language.
What changes would you like to see in this activity/field?
Another challenge is the huge work of mapping MST with some of the coding schemes which are currently in use. This would include mapping MST with ICD, a statistical classification system used to produce data for reimbursement etc., and SNOMED CT, used to code clinical terms & procedures. In the UK, OPCS (Office of Population Censuses and Surveys Classification of Interventions and Procedures) is also used mainly used to classify procedures.
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