Databases for gastrointestinal endoscopy

Databases for gastrointestinal endoscopy

8. During the development of the new Medicare fee schedule, and other recent governmental initiatives which impact on gastrointestinal practice and re...

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8. During the development of the new Medicare fee schedule, and other recent governmental initiatives which impact on gastrointestinal practice and research, the national affairs committees of the gastrointestinal societies have banded together to provide prompt, critical review of pending actions. For example, a tripartite committee of AGA, A/ S/G/E, and ACG closely monitored the development of RBRVS from 1989 to 1991. The presidents of these and other societies, in conjunction with the appropriate committees have jointly expressed strong objection to the obvious inequities of the fee schedule as it affects gastroenterology. This has led to significant positive adjustments in the global fee policy and correction of discrepancies in the relative value units for the major families of endoscopic procedures. Currently, an even more impressive number of cooperative ventures are taking place or are in the planning stage: The presidents and president-elects of the four national medical gastrointestinal societies, AGA, ACG, A/S/G/E, and AASLD, have agreed to meet biannually to discuss issues of common concern. During the last meeting of this group in January 1992, commitments were made for a jointly sponsored training directors workshop; a national affairs workshop to inform our respective governing boards, national affairs committees, lobbyists, and executive directors, of current and future governmental actions; the future development of collaborative recertification programs in anticipation of scheduled recertification board examinations; greater dedication of joint resources to the preparation and review of scientifically based clinical guidelines; and an intersociety committee to consider collaboration in the development of a national physicians volunteer program begun by ACG. For the first time, the annual scientific program committees of AGA, A/S/G/E, and AASLD met simultaneously at a common site in February 1992. This allowed frequent interchange as each society planned its scientific program for DDW. This interaction reduced or eliminated simultaneous competing clinical sessions and resulted in joint topic fora at which papers or posters from more than one society will be presented during a single session. It is hoped that these small, but revolutionary beginnings may lead to future submission of abstracts with a common theme to a single intersociety review committee. The gastrointestinal societies contributed both financial resources and manpower to the successful bid to bring the 10th World Congress of Gastroenterology to Los Angeles in 1994. Planning committees comprised of members of all gastrointestinal societies are currently developing the scientific and educational programs for this important event. These are some of the specific cooperative programs that are underway. A/S/G/E is also currently pursuing additional new initiatives with the American Society of Colon and Rectal Surgeons, the North American Society of Pediatric Gastroenterology and Nutrition, and the College of American Pathologists. The reasons for and advantages of greater intersociety cooperation are compelling. First, we are after all largely the same people with the same problems and goals. A recent cross-comparison of society rosters showed that about 60% of A/S/G/E members belong to AGA and nearly 30% are members of ACG. Conversely, over 40% of AGA members are also active members of A/S/G/E. Second, there is clearly VOLUME 38, NO.3, 1992

greater strength in speaking with a single voice, especially when dealing with non-medical governmental or practice issues. The weight of opinion is often nearly as influential as the rationale of a given argument. Furthermore, economies of resources often result from collaboration. Successful innovations introduced by one society may be efficiently and promptly applied to problems facing other gastrointestinal societies without the wasteful need to repeatedly "reinvent the wheel." Unnecessary overlapping effort is a luxury none of us can afford. Last, we have to accept the reality that no outside agency is likely to accept the validity of our individual proposals if we cannot reach agreement among ourselves. Credibility in many areas demands intersociety cooperation and consensus. Ultimately, of course, the strongest argument for shared effort is that every gastrointestinal medical society has exactly the same fundamental goal; that is, ensuring the highest quality of care for patients with digestive disease. Should the current national gastrointestinal societies merge into one or more larger societies? Over the past 10 years there has been some sentiment for a move in this direction. My opinion at this time is no. I do not favor a merger of any of the existing major societies for the following reasons. While the benefits of greater cooperation are obvious, there is still, I believe, value in maintaining the separate, individual identities of these organizations. Although there is strength in combined effort, greater focus and more imaginative approaches to problems often are a result of both the unique identity and the past history of each society. Smaller societies dedicated to defined, limited areas of interest may provide greater degrees of representation and a stronger voice for individual members. In addition' there is some positive benefit from friendly competition as long as we can continue our recent record of open communication and sharing, and as long as we can quickly band together to confront new problems and accomplish common goals. For the near future then, I believe we should remain a "confederation" of gastrointestinal societies without appreciable intersociety barriers to the sharing of information, financial resources, or personal talents and energies as we work for the benefit of our members and our patients.

REFERENCES 1. Winawer SJ, Ritchie MT, Diaz BJ, et al. The National Polyp

Study: aims and organization. Front Gastrointest Res 1986;10:216-25. 2. Fleischer DE, Goldberg SB, Browning TH, et al. Detection and surveillance of colorectal cancer. JAMA 1989;261:580-5.

Letters to the Editor Databases for gastrointestinal endoscopy To the Editor: Naffah 1 in his editorial discussed the requirements for computerized databases in digestive endoscopy and pointed to the need for building a system which could be used in computer-aided programs both in practice and research. In 395

the references he quoted many important contributions to this topic. It may be appropriate to add that the committee for terminology and data processing of the World Society for Gastrointestinal Endoscopy (OMED) has developed a system of endoscopic nomenclature which is the result of consensus of a group of leading endoscopists from all over the world, and can be regarded as an agreed standard database of digestive endoscopy. The publication of this document first appeared in 1984 in English and subsequently in six other languages. 2 The second edition, revised, updated, and complemented, has so far appeared in seven languages,3 further translations are in preparation. Video films showing examples of the findings and terms related to the OMED nomenclature have been also produced,4 and an atlas of colored photographs is in print. 5 A number of articles have been published regarding the work of the OMED Committee. 6- 15 The members of the committee met repeatedly with the representatives of the major producers of endoscopic instruments and agreed on coordinating efforts to create a common language to be used by endoscopists all over the world, and to integrate it into programs accompanying the new instruments. Those who are interested in obtaining these OMED publications or video films can request information and free copies from the firms sponsoring them or from the producer. Zdenek Maratka, MD Charles University Prague, Czechoslova~a

15. Maratka Z. Terminology of endoscopic findings in teaching and postgraduate education in gastroenterology. Acta Endosc (in press).

Gastrointestinal lipoma To the Editor: We agree with Christie 1 that the majority of colonic lipomas should be left alone. Removal is indicated only in the one third of cases which are symptomatic, or if a neoplastic lesion cannot totally be excluded. Endoscopic polypectomy is appropriate if the lesion is well pendunculated or perhaps extraperitoneal, otherwise a limited surgical resection may be preferable. Although various endoscopic and radiological features of gastrointestinal lipomas have been described it is usually difficult to make a definitive diagnosis prior to endoscopic or surgical removal. We 2 and others3. 4 have found computed tomography with luminal contrast useful for definitive diagnosis of larger lesions. Fat can be reliably distinguished by a low Hounsfield value. Gastrointestinal liposarcomas are extremely rare, and those which have been examined by computed tomography were usually heterogenous with septa and areas of non-fatty tissue. Therefore, homogeneous fatty lesions can be safely diagnosed as lipomas. 4 Endoscopic ultrasonography has also been reported to be a useful diagnostic test. 5 With a confident diagnosis made, the asymptomatic lesion can be left alone while a limited resection can be performed for lesions requiring surgery.

REFERENCES 1. Naffah F. Databases for gastrointestinal endoscopy. Gastrointest Endosc 1991;37:488-90. 2. Maratka Z, et a1. Terminology, definitions and diagnostic criteria in digestive endoscopy. Scand J Gastroenterol 1984;19(suppl 103):1-74. 3. Maratka Z, et a1. Terminology, definitions and diagnostic criteria in digestive endoscopy. 2nd ed. Bad Homburg, Germany: Normed Verlag, 1989. 4. Cosentino F, et a1. Videofilm to the OMED nomenclature. Bad Homberg, Germany: Normed Verlag, 1991. 5. Maratka Z, et a1. Picture documentation to the OMED nomenclature. Atlas of endoscopic findings. Bad Homburg, Germany: Normed Verlag, 1992. 6. Maratka Z. The difficulties of achieving clarity in endoscopic terminology. Gastrointest Endosc 1982;28:113-4. 7. Maratka Z. Toward a better endoscopic terminology. Gastrointest Endosc 1983;29:136-7. 8. Maratka Z, Shonovit 0, Petr P, Kuchar J, Reuter C. La terminologie endoscopique de I'OMED et son application it l'ordinateur dans Ie service d'endoscopie digestive. Acta Endosc 1986;16:123-8. 9. Maratka Z. The international OMED endoscopic terminology and its application to computer-aided data processing. Ital J Gastroenterol 1988;20:95-6. 10. Maratka Z, et a1. Terminology and computerisation of endoscopic records-panel discussion. Endoscopy 1989;21:36-7. 11. Maratka Z, Schapiro M. Terminology and its application to computer-aided data processing in digestive endoscopy. J Clin GastroenteroI1990;12:130-1. 12. Maratka Z. Moderner fortbildungsmodus in der endoskopie. Fortschritte der gastroent. Endoskopie 1990;20:1-2. 13. Maratka Z. Evolution ofterminology and endoscopic computerisation. Acta Endosc 1991;21(suppl):371-3. 14. Maratka Z. The role of terminology in medical education and training. Scand J Gastroenterol (in press).


J. Y. Kang, MD Department of Medicine Division of Gastroenterology National University Hospital Singapore

REFERENCES 1. Christie JP. The removal of lipomas. Gastrointest Endosc 1990;36:532-3. 2. Kang JY, Chan-Wilde C, Wee A, Chew R, Ti TK. Role of computed tomography and endoscopy in the management of alimentary tract lipomas. Gut 1990;31:550-3. 3. Megibow A, Redmond PE, Bosniak MA, Horowitz L. Diagnosis of gastrointestinal lipomas by CT. AJR 1979;133:743-5. 4. Heiken JP, Forde KA, Gold RP. Computed tomography as a definitive method for diagnosing gastrointestinal lipomas. Radiology 1982;142:409-13. 5. Calletti G, Zani L, Bolondi L, Brocchi E, Rollo V, Barbara L. Endoscopic ultrasonography in the diagnosis of gastric submucosal tumour. Gastrointest Endosc 1989;35:413-8.

PEG tube removal and steroids To the Editor: The removal of PEG tubes has received recent attention in the literature in regard to both technique l - 3 and potential complications. 4,5 Additionally, the potential deleterious effects of steroid therapy on esophageal structure has been @[email protected]