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Abstract

The authors thank Dr Brandt1Brandt L.J. Terminology for vascular lesions of the GI tract.Gastrointest Endosc. 2018; 87: 1595-1596Abstract Full Text Full Text PDF Scopus (2) Google Scholar for his review of this article2Becq A. Rahmi G. Perrod G. et al.Hemorrhagic angiodysplasia of the digestive tract pathogenesis, diagnosis, and management.Gastrointest Endosc. 2017; 86: 792-806Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar and his comments. To this day, a consensus definition and description of vascular lesions of the GI tract does not exist. As written in our article and in clinical practice, multiple terms are used to describe these lesions, such as angiodysplasia, arteriovenous malformations, telangiectasia, angioectasia, and vascular ectasia.3Delvaux M. Friedman S. Keuchel M. et al.Structured terminology for capsule endoscopy: results of retrospective testing and validation in 766 small-bowel investigations.Endoscopy. 2005; 37: 945-950Crossref PubMed Scopus (33) Google Scholar We understand that the multitude of terms is dismaying; however, this is simply a report of the reality of things. The clinical relevance of these vascular lesions is the associated risk of bleeding. When these lesions are diagnosed, ablation therapy is the first-line treatment when needed. Endoscopic sampling or surgery followed by pathologic examination is rarely, if ever, performed to confirm any visual diagnosis. Thus, in clinical practice, by referring to the table provided, one’s choice between these terms would be difficult. This would be confusing, and most would end up using the word “angiodysplasia.” Our decision to use this term is clearly supported by this table: “A good term to use when the histology of a small vascular lesion or its pathophysiology is unknown.” Further, in Europe it is the most commonly used term. However, experts argue that the suffix “dysplasia” is inappropriate from a pathologic point of view, which this letter fails to mention. All in all, no term is appropriate given that, again, no consensus exists. The Capsule Endoscopy Structured Terminology was written in the 2000s by a group of experts, providing a common lexicon in the setting of lesions seen on video capsule endoscopy.3Delvaux M. Friedman S. Keuchel M. et al.Structured terminology for capsule endoscopy: results of retrospective testing and validation in 766 small-bowel investigations.Endoscopy. 2005; 37: 945-950Crossref PubMed Scopus (33) Google Scholar Currently, this terminology is still in use, although it is limited by the lack of semantic definition of vascular lesions. Leenhardt et al are currently working on a consensus for the description of these lesions (International Delphi Consensus Statement). Terminology for vascular lesions of the GI tractGastrointestinal EndoscopyVol. 87Issue 6PreviewThe recent article by Becq and colleagues1 on hemorrhagic angiodysplasia of the digestive tract caused me some dismay. Although well-written, informative, and up-to-date, it was a disservice to those of us who have been striving to establish a standard vocabulary for vascular lesions: one that is accurate, understandable, based on histology and physiologic studies whenever possible, and that serves to communicate more understandably than when terms are used almost at random. An example of the confusion in terminology that prompted my displeasure was “…the term ‘gastrointestinal angiodysplasia’… today these lesions are commonly named arteriovenous malformations, telangiectasia, angiectasia or vascular ectasia.” I plead for us to be mindful of the etymologic roots from whence these lesions sprang and to use them in as accurate a way as possible (Table 1). Full-Text PDF