1. September 2015 Sumiko Nagoshi Geoffrey Farrell Tomoaki Tomiya Progress Report Hepatology and PancreaticoBiliary (HPB)

2. HPB WG members RolesNameAffiliations ChairGeoffrey FarrellANU, Canberra, Australia Managing editorTomoaki Tomiya Saiatama Medical University, Japan memberSumiko Nagoshi Saiatama Medical University, Japan Reviewer(s)

3. Progress report (1) 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,

4. 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’.

5. Southern ChinaJapan (2014) (World J Gastroenterol 2014; 20: 13546) Etiology of Liver Cirrhosis HBV HCV ALD Others HCV

6. 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 cirrhosis Chronic hepatitis C with cirrhosis

7. Progress report (1) (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.

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

9. Vascular complications of portal hypertension Oesophageal varices, without haemorrhage Oesophageal varices, with haemorrhage Gastric varices with haemorrhage Gastric varices without haemorrhage Oesophageal and gastric varices with haemorrhage Oesophageal and gastric varices without haemorrhage Portal hypertensive gastropathy with haemorrhage Portal hypertensive gastropathy without haemorrhage Colorectal varices with haemorrhage Colorectal varices without haemorrhage Intestinal varices not otherwise specified, with haemorrhage Intestinal varices not otherwise specified, without haemorrhage Ascites with spontaneous bacterial peritonitis Ascites without complications Ascites with hernia Refractory ascites Ascites with hepatic hydrothorax Type 1 hepatorenal syndrome Type 2 hepatorenal syndrome Hepatorenal syndrome, not otherwise specified Hepatopulmonary syndrome Portopulmonary hypertension Cirrhotic cardiomyopathy Hepato Adrenal syndrome Other specified complications of cirrhosis Multiple complications compromising liver failure Ectopic varices Portal hypertensive biliopathy Supplemetary classification for complications of chronic liver disease and cirrhosis Hepatic encephalopathy Minimal Hepatic encephalopathy Acute hepatic encephalopathy in cirrhosis Acute hepatic encephalopathy in acute liver failure Chronic hepatic encephalopathy Hepatic encephalopathy Relapsing chronic hepatic encephalopathy Persistent chronic hepatic encephalopathy Portosystemic shunts GI area infection MG66 Ascites (Extension code) Certain specified inflammatory liver diseases Move to ‘Certain specified diseases of liver’ or ‘Extension code’?

10. ICD-10 ‘Hepatitis A with hepatic coma’ is not ‘1E40 Acute hepatitis A’ + ‘Certain specified inflammatory liver diseases’.

11. 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) (continued) For example,

12. Benign neoplasm of digestive organs Extension 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.   

13. 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) (continued)

14. Progress report (2) 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.

15. Progress report (3) 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.

16. Next steps Remaining issuesExpected outcome Corrections of JMMLS via the proposal mechanism in the beta browser Final confirmation of the definitions Construction of Extension codesMapping between ICD-10 and JLMMS