World Organisation of Digestive Endoscopy

MST: a universal endoscopic language through OMED

MST: a universal endoscopic language through OMEDThe Minimal Standard Terminology for Endoscopy (MST) is released in a revised version 3.0, bringing this important collaborative tool up to standards with modern endoscopy.

The global efforts preceding the current version was initiated in1991, by a collaborative effort from all the major endoscopy societies worldwide.

The list of terms proposed relied heavily upon the original and detailed work performed by the OMED committee under the chairmanship and guidance of Pr. Z. Maratka (1). His book provides the framework, as well as the definitions for most of the MST terminology, and offers a reference for users unfamiliar with the words employed.

The initial version, MST 1.0  (2,3) formed the basis for prospective testing of the Terminology in Europe and the United States, by the American Society for Gastrointestinal Endoscopy (ASGE).  This resulted in  MST 2.0, released  in 2000.  Since then, this version of the MST has been implemented in a number of software solutions, mostly with various  modifications.

MST 3.0

The MST copyright and responsibility was recently transferred to the OMED society for further development. The committee of terminology and standardization has been in charge of this task (table I), which has resulted in the present MST 3.0 version. While the original ideas of Prof. Maratka, ESGE, ASGE and the Gaster project have been retained, some modifications have still been put in place in this revision, summarized below:

  • EUS and enteroscopy (including capsule endoscopy) have been included. The previously published EUS terminology (including definitions)  (5) is included in recent versions of the Maratka book, and forms the basis for the present EUS MST.  As for enteroscopy, and effort was made to accommodate all endoluminal imaging modalities visualizing the small bowel, including capsule endoscopy,  utilizing joint terms and with the same principles of attributes and attribute values as in the rest of the MST document.
  • To avoid redundancies and inherent contradictions, the document has been somewhat reorganized, with one generic list of findings for each main category (luminal, ERCP, EUS). This is coupled with a table to indicate which findings are relevant for which organ.
  • This way, the description of a polyp remains the same regardless of the organ involved.  This also allows a luminal section to be included in an ERCP reporting software module including the same structure as for an upper endoscopy.
  • The ERCP terminology has been revised to allow more precise description of maneuvers, as well as findings.
  • Updated internationally recognized classifications have been included as attributes wherever relevant.
  • The lists for indications (reasons for endoscopy) and diagnoses have been extended and somewhat revised.
  • The section on therapy has been revised and expanded to reflect recent technical development.
  • A new section on reporting of adverse events has been developed offering description and grading of intra- as well as post-procedure events.

The complete MST 3.0 document is available free of charge for downloading at the OMED website (www.omed.org), and is free to use in any commercial or non-commercial context as long as the copyright requirement are being honored (fig 1).

Modifications of the MST

While offering standards for core items, the MST committee recognizes the dynamics and differences within endoscopy worldwide.  The terminology must offer, even encourage, enough flexibility for users to accept the inherent structure and limitation of any standard. Thus, making modifications within the recommendations in the copyright statement is probably vital to an acceptable role of the MST.

The MST offers a selection of terms and attributes for appropriate description of findings, procedures and complications. It does not offer a complete reference for the endoscopic report. However, when developing software for endoscopic reporting, the MST should be considered as structuring guidance and for initial selection of list terms available.

Local modifications that are endorsed, without obstructing the principles of the MST are:

  • Adding items to a list
  • Removing irrelevant items from a list
  • Adding sub-classifications within the main MST items
  • Adding attributes with corresponding values

Minimal standard documentation

While the present MST document offers a template for main sections of the endoscopy report and standardizes well the descriptions of the findings per se, it is not a complete description of the endoscopy documentation. Thus, the OMED committee has set out to develop additional standardizing recommendations to supplement the current MST 3.0 document:

  • MSR – Minimal standard reporting.  This will offer structure and content recommendation for all the main endoscopic procedures, including formal, technical, as well as medical elements. This document will link closely to current quality control parameters that are currently being implemented in a number of national quality programs.
  • MSI – Minimal standard imaging.  This will give recommendations on image documentation – of normal procedures (e.g. coecal intubation), as well as focal and diffuse findings.  This will hopefully improve the practical output of the imaging facilities presently being available in most commercially available endoscopy reporting softwares.

References

  1. Maratka, Z. Terminology, definitions and diagnostic criteria in digestive endoscopy. Scand J Gastroenterol 1984;19(suppl 103):1-74.
  2. ESGE Committee for Minimal Standards for Terminology and Documentation in Digestive Endoscopy. Minimal Standard Terminology for Databases in Digestive Endoscopy. Bad Homburg, Germany: NORMED Verlag, 1995.
  3. Crespi M, Delvaux M, Schapiro M, Venables C, Zweibel F.  Working Party Report by the Committee for Minimal Standards of Terminology and Documentation in Digestive Endoscopy of the European Society of Gastrointestinal Endoscopy: Minimal Standard Terminology for a Computerized Endoscopic Database. Am J Gastro 1996;91:191-216.
  4. Aabakken L. Standardized terminology in endoscopic ultrasound. Eur J Ultrasound. 1999;10:179-83

Tables

TABLE I. OMED committee for terminology and standardization

  • Lars Aabakken, Norway (chairman)
  • Masayuki Fujino, Japan
  • Glen Eisen, USA
  • Bjorn Rembacken, UK
  • Olivier leMoine, Belgium
  • Thomas Rösch, Germany
  • Konstantin Kuznetzov, Russia
  • Jean-Francois Rey, France
  • Peter Cotton, USA

 

Figures

Figure 1 .  Web access to the MST documents at http://www.omed.org