September 2015

Sumiko NagoshiGeoffrey FarrellTomoaki Tomiya

Progress Report Hepatology and PancreaticoBiliary

(HPB)

HPB WG members

Roles Name Affiliations

Chair Geoffrey Farrell ANU, Canberra, Australia

Managing editor Tomoaki Tomiya Saiatama Medical University, Japan

member Sumiko Nagoshi Saiatama Medical University, Japan

Reviewer(s)

Progress report (1)<Classification Hierarchy>

1. In the 6th Face-to-Face Meeting of IM TAG being held in December 2014, we decided the shoreline of the JLMMS.

2. The shoreline in our priority area was accepted, but in the overlapping area with other TAGs like ‘Infectious diseases’ and ‘Neoplasm’ our proposals have not been accepted.

3. Because of the different concepts of shoreline among TAGs, there are heterogeneous classification hierarchy within ‘Liver diseases’ area.

We confirmed the hierarchy of the ICD-11 JLMMS.

For example,

Viral hepatitis

ICD-11 JLMMS HPB chapter (now) aAlcoholic liver disease

Non-alcoholic liver disease

Drug-induced and toxic liver disease

“Cirrhosis” is listed in ‘ Alcoholic, non-alcoholic, drug-induced and toxic liver diseases’, but not in ‘chronic viral hepatitis’.

Southern ChinaJapan (2014)

(World J Gastroenterol 2014; 20: 13546)

Etiology of Liver Cirrhosis

HBV

HBVHCV

ALD

ALD

Others Others

HCV

Viral hepatitis

ICD-11 JLMMS HPB chapter (now) aAlcoholic liver disease

Non-alcoholic liver disease

Drug-induced and toxic liver disease

“Chronic hepatitis B / C with cirrhosis” is necessary in ‘Diseases of the digestive system’.Shoreline concept should be homogeneous.

Chronic hepatitis B with cirrhosisChronic hepatitis C with cirrhosis

Progress report (1)<Classification Hierarchy> (continued)

4. We proposed ‘Supplemetary classification for complications of chronic liver disease and cirrhosis’ for Extension codes in May 2013. However, the items are absent in Extension codes. Therefore, the important items were missing or thrown into improper areas.

‘hepatic encephalopathy, etc.’ are included by ‘Certain specified inflammatory liver diseases’.

Vascular complications of portal hypertensionOesophageal varices, without haemorrhageOesophageal varices, with haemorrhageGastric varices with haemorrhageGastric varices without haemorrhageOesophageal and gastric varices with haemorrhageOesophageal and gastric varices without haemorrhagePortal hypertensive gastropathy with haemorrhagePortal hypertensive gastropathy without haemorrhageColorectal varices with haemorrhageColorectal varices without haemorrhageIntestinal varices not otherwise specified, with haemorrhageIntestinal varices not otherwise specified, without haemorrhageAscites with spontaneous bacterial peritonitisAscites without complicationsAscites with hernia Refractory ascites Ascites with hepatic hydrothoraxType 1 hepatorenal syndromeType 2 hepatorenal syndromeHepatorenal syndrome, not otherwise specified

Hepatopulmonary syndromePortopulmonary hypertensionCirrhotic cardiomyopathyHepato Adrenal syndromeOther specified complications of cirrhosisMultiple complications compromising liver failureEctopic varices Portal hypertensive biliopathy

Supplemetary classification for complications of chronic liver disease and cirrhosis

Hepatic encephalopathy

Minimal Hepatic encephalopathyAcute hepatic encephalopathy in cirrhosis Acute hepatic encephalopathy in acute liver failure Chronic hepatic encephalopathy

Hepatic encephalopathyRelapsing chronic hepatic encephalopathy Persistent chronic hepatic encephalopathy Portosystemic shunts

GI area

infectionMG66 Ascites(Extension code)

Certain specified inflammatory liver diseasesMove to ‘Certain specified diseases of liver’or ‘Extension code’?

ICD-10

‘Hepatitis A with hepatic coma’ is not ‘1E40 Acute hepatitis A’ + ‘Certain specified inflammatory liver diseases’.

5. In July 2014, PancreaticoBiliary WG was organized at Japanese Society of Gastroenterology and discussed classification hierarchy of JLMMS.

6. PancreaticoBiliary WG members pointed out some problems especially in JLNNS of ‘Neoplasms of pancreas’.

Progress report (1)<Classification Hierarchy> (continued)

For example,

Benign neoplasm of digestive organsExtension codes Histopathology

• The incidence of ‘Intraductal papillary mucinous neoplasm of pancreas (IPMN)’ is recently increasing.

• It is impossible to clinically decide the grade of dysplasia and select proper Extension code.

7. We picked up many problems which should be resolved in JLMMS of ‘Diseases of liver, gallbladder, biliary tract and pancreas’, and will make proposals in the beta browser .

Progress report (1)<Classification Hierarchy> (continued)

Progress report (2)<Definitions>

1. In the 6th Face-to-Face Meeting of IM TAG, Prof. Farrell revised definitions of ‘viral hepatitis’.

2. In JLMMS, the input of definitions is almost completed. After correction of the structure of JMMLS, we will confirm the definitions again.

Progress report (3)<Transfer of ICD-10 Entities>

• In the areas under your WG's responsibility, are all ICD-10 entities able to be mapped to ICD-11?

We have not performed mapping between ICD-10 and ICD-11 JLMMS.

In the 6th Face-to-Face Meeting of IM TAG, it was announced that mapping was not our responsibility. We may comment about the problems.

Next steps

Remaining issues Expected outcome

Corrections of JMMLS via the proposal mechanism in the beta browser Final confirmation of the definitions

Construction of Extension codes Mapping between ICD-10 and JLMMS