Table Of ContentI
II
III
Grading and Staging in Gastroenterology
Guido N.J. Tytgat, MD, PhD, FRCP
Professor Emeritus in Gastroenterology
University of Amsterdam
Academic Medical Center Amsterdam
The Netherlands
Stefaan H.A.J. Tytgat, MD
Pediatric Surgeon
University of Utrecht
University Medical Center Utrecht
The Netherlands
220 illustrations
Thieme
Stuttgart · New York
IV
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V
Introduction
Staging and grading is indispensable when analyzing disease themselves. Illustrations such as sketches, high-quality line
severity,therapeuticoutcomes,orqualityoflifeinasystematic drawings,andendoscopyorhistologyphotographswereadded
reproducible fashion. Staging systems mainly focus on the toclarifyorillustratecertainfeatures.Specialcarewastakento
developmentofagivendiseaseovertime.Stagingusuallyin- providetheexactliteraturereferencesfromwhichthestaging/
cludesadimensionofseverityandshouldideallycorrespondto gradingsystemswereextracted.Auniform,concisewayofpre-
therapeutic measures required. Grading systems systematize sentationwasattemptedthroughoutthebook.Itwouldhave
theinformationoftenobtainedbyassigningnumericalvalues beenimpossibletogivein-depthcoverageofallpossiblestag-
to certain conditions. The numbers generated usually corre- ingandgradingsystemseverusedwithinthegastroenterology
spondto(sub-)categoriesinarankingsystem,wherebythedi- literature.Thereforesomeinstrumentsareonlymentionedby
mensionsofthecategoriesandtheintervalsseparatingthem titleorcommenteduponbriefly,butalwaysadequatelyrefer-
are often unequal or even poorly defined. A most important enced for reasons of completeness. The interested reader is
purposeofastagingandgradingsystemistoprovideastruc- guidedtothefulltextviathereferencelist.Theauthorsdoreal-
tureforcommunicationamongcliniciansandinvestigators.It ize that omissions are inevitable in a dynamic field such as
provides a framework upon which all those interested can gastroenterologywithnewinstrumentsregularlyforthcoming.
begin to communicate observations and interpretations con- The large amount of material involved and the constant
cerning pathophysiology and mechanisms of disease, disease developmentofnewinstrumentsmakeitimpossibletoachieve
expression,andresponsetotherapeuticinterventions. anythinglikeanexhaustivepresentation.
Accurate staging and grading is of vital importance in any Thebookcanbeusedindifferentways,butitisprimarilya
discipline for adequate diagnosis, differentiation of disease, workofreferences,availableathandsreach.Thesubjectindex
patient care, and appropriate therapy. This also applies to shouldprovideeasyaccesstoagiveninstrument.Occasionally
gastroenterology-hepatology.Currentlythereisnosynopsisof working through individual chapters to obtain an overview,
themostrelevantstagingandgradingsystemsusedinourdis- andthencomparingthedifferentinstruments,mayalsobea
cipline.Theauthorsofthiscompendiumfeelthatthisabsence helpfulmethod.
signifies an important unmet need, especially for fellows in Theauthorshopethatthissynopsiswillfillavacuuminour
training,fortheinterestedclinicianinpractice,andfortheclin- discipline.Althoughprimarilyaimedatfellowsintrainingand
icianinacademiawithinterestinteachingandeducation.This professionals in gastroenterology, including gastrointestinal
compendiumisthefirstattempttoprovideacomprehensive surgeons,pediatricians,andbasicresearchers,thisatlasshould
summaryofrelevantstagingandgradingsystemsingastroen- alsobeavailablefornursingpractitioners,researchnurses,and
terology. representativesofthededicatedbiomedicalindustry.Maythis
Afterexhaustivescreeningoftheliterature,relevantstaging miniencyclopediaultimatelyenhanceinterestingastroenter-
and grading systems were identified and collated into three ology-hepatologyandtransmitabetterunderstandingofdis-
majordomains:genericstaging/gradingsystems,moreorgan-/ easeseverity,furtheroptimizingtherapeuticstrategiesforthe
disease-specificsystems,anddisease-relatedqualityoflifein- benefitofthepatientswecarefor.
struments. Where appropriate, explanatory comments were
added to the grading systems, but our comments are as re- GuidoN.J.Tytgat
served and objective as possible to enable users to judge for StefaanH.A.J.Tytgat
VI
VII
Table of Contents
Chapter1 InstrumentsforOverallPatientandDiseaseAssessment
PerformanceStatus................................. 3 InfectiousDisorders:Prophylaxis ..................... 51
MentalStatus...................................... 6 CausticInjury ...................................... 54
NutritionalStatus .................................. 10 Neoplasia ......................................... 57
HydrationStatus ................................... 13 Chemotoxicity:DrugToxicity ........................ 68
GradingofSeverityofDisease—OrganFailure .......... 16 TreatmentEvaluation ............................... 73
ComorbidDisease .................................. 35 LevelofEvidence:StudyQuality...................... 76
FunctionalDisorders................................ 39 Miscellaneous...................................... 79
Vascular/BleedingDisorders ......................... 43
Chapter2 Organ-RelatedStagingandGrading
Oropharynx ....................................... 83 VascularDisorders ................................ 191
AnatomicalVariants .............................. 83 InflammatoryDisorders............................ 192
Inflammation .................................... 84 NeoplasticLesions ................................ 230
NeoplasticLesions ................................ 85 Liver.............................................. 240
Esophagus ........................................ 88 Anatomy,Injury .................................. 240
Symptoms ...................................... 88 Infection ........................................ 244
AnatomicalVariants .............................. 98 Hepatitis,Cirrhosis................................ 246
VascularDisorders ................................ 100 HepaticFailure,LiverTransplantation ................ 264
InfectiousDisorders............................... 107 HepaticEncephalopathy ........................... 266
InflammatoryDisorders:GERD ...................... 108 Neoplasia ....................................... 269
NeoplasticLesions ................................ 113 BiliarySystem ..................................... 274
Stomach .......................................... 120 Symptoms ...................................... 274
Symptoms ...................................... 120 Anatomy,Injury .................................. 275
AnatomicalVariants,Injury......................... 125 GallstoneDisease................................. 282
VascularDisorders ................................ 127 ERCP ........................................... 284
InflammatoryDisorders............................ 130 Cholangitis ...................................... 287
NeoplasticLesions ................................ 146 Neoplasia ....................................... 290
SmallIntestine..................................... 160 Pancreas .......................................... 296
AnatomicalVariants,Injury......................... 160 Anatomy,Injury .................................. 296
InflammatoryDisorders............................ 163 Pancreatitis...................................... 298
Neoplasia ....................................... 167 Neoplasia ....................................... 307
Colon ............................................. 170 Spleen ............................................ 311
Symptoms ...................................... 170 SplenicInjury .................................... 311
FunctionalDisorders .............................. 181 PeritonealCavity ................................... 312
AnatomicalVariants,Injury......................... 186
Chapter3 AssessmentofQualityofLife(QoL)
Introduction ....................................... 317 (B)Disease-SpecificQoLInstrument .................. 344
AspectsofValidity ................................. 318 QoLinObesityandPostobesitySurgery .............. 354
AspectsofReliability ............................... 319 OtherHealth-RelatedQualityofLifeInstrumentsUsed
Bias ............................................ 319 inPatientswithChronicLiverDiseasebyTitle ......... 364
(A)GlobalGenericQoLAssessments .................. 320
SleepDisorderAssessment ......................... 340 Index ............................................. 369
Disability,AssessmentofQualityofLifebyTitle........ 340
IllnessintheAged ................................ 340
VIII
1
Chapter 1 Instruments for Overall Patient and
Disease Assessment
PerformanceStatus.......................... 3 InfectiousDisorders:Prophylaxis .............. 51
MentalStatus .............................. 6 CausticInjury ............................... 54
NutritionalStatus ........................... 10 Neoplasia .................................. 57
HydrationStatus ............................ 13 Chemotoxicity:DrugToxicity ................. 68
GradingofSeverityofDisease—OrganFailure .... 16 TreatmentEvaluation ........................ 73
ComorbidDisease ........................... 35 LevelofEvidence:StudyQuality ............... 76
FunctionalDisorders ......................... 39 Miscellaneous .............................. 79
Vascular/BleedingDisorders .................. 43
