The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria.
OBJECTIVE
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.
Sharma
Prateek
P
Department of Veterans Affairs Medical Center, University of Kansas School of Medicine, Kansas City, Missouri, USA. psharma@kumc.edu
Dent
John
J
Armstrong
David
D
Bergman
Jacques J G H M
JJ
Gossner
Liebwin
L
Hoshihara
Yoshio
Y
Jankowski
Janusz A
JA
Junghard
Ola
O
Lundell
Lars
L
Tytgat
Guido N J
GN
Vieth
Michael
M
D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D004724:Endoscopy; D006801:Humans