Gastroenterology

Gastroenterology

Volume 131, Issue 5, November 2006, Pages 1392-1399
Gastroenterology

Clinical–alimentary tract
The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus: The Prague C & M Criteria

https://doi.org/10.1053/j.gastro.2006.08.032Get rights and content

Background & Aims: Barrett’s esophagus (BE) is a premalignant condition for esophageal adenocarcinoma, its diagnosis relying initially on recognition of a columnar-lined distal esophagus. We aimed to develop and validate explicit, consensus-driven criteria for the endoscopic diagnosis and grading of BE. Methods: An international working group agreed on criteria and developed materials for their formal evaluation using video-endoscopic recordings gathered in a standardized manner in 29 patients. The criteria included assessment of the circumferential (C) and maximum (M) extent of the endoscopically visualized BE segment as well as endoscopic landmarks. The recordings were scored according to these criteria by a separate international panel of 29 endoscopists. Results: The Prague C & M Criteria give explicit guidance on the endoscopic recognition of BE and grading of its extent. The overall reliability coefficients (RC) for the assessment of the C & M extent of the endoscopic BE segment above the gastroesophageal junction were 0.95 and 0.94, respectively. The rates of exact agreement (for C & M values) for pairwise comparisons of individual patient values were 53% and 38%, respectively, whereas the values for agreement within a 2-cm interval were 97% and 95%, respectively. The overall RC for endoscopic recognition of BE ≥1 cm was 0.72, whereas for BE <1 cm, it was 0.22. The RCs for recognizing the location of the gastroesophageal junction and the diaphragmatic hiatus were 0.88 and 0.85, respectively. Conclusions: The Prague C & M Criteria have high overall validity for the endoscopic assessment of visualized BE lengths.

Section snippets

Working Group Structure and Meetings

A subgroup of the International Working Group for the Classification of Oesophagitis (IWGCO), the authors of this report, was assembled to develop criteria for endoscopic detection and grading of BE that would be useful in both clinical practice and research trials. All the members of the subgroup have a research and clinical interest in BE, and one is a statistician. The first meeting was convened in September 2002, and, here, strategies for development of criteria for grading of BE were

Endoscopic Landmarks and Development of a Classification System

A series of statements about the recognition of key landmarks pertinent to the endoscopic recognition and classification of BE were developed and rated by the group (Table 1). This process highlighted the pivotal importance of accurate localization of the GEJ for the diagnosis of BE and also for the measurement of its extent. Review of the literature relevant to the endoscopic location of the GEJ showed a lack of validation of any of the criteria proposed. None of these criteria were originally

Discussion

At present, standardized, validated criteria for the endoscopic description of BE are not routinely used. Endoscopists currently adopt a loose classification system, defining endoscopic segments of BE as “long,” “short,” or “ultra-short,” without there being an established cutoff or clinical significance for any of these categories.7 Moreover, considerable variation in the ability to detect, classify, and measure the endoscopic extent of BE has been reported.8, 9

To deal with these issues, we

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    Supported by an unrestricted educational grant from AstraZeneca.

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