When and how to grade Barrett's columnar metaplasia: the Prague system.
Barrett's oesophagus (BO), a well-known precursor for oesophageal adenocarcinoma has been generating a great deal of controversy. The initial step in diagnosing BO requires an accurate endoscopic recognition of the columnar lined oesophagus. A reliable diagnosis of BO depends on its effective endoscopic recognition based on the key anatomic landmarks, followed by histological sampling of the columnar-lined epithelium. Precise localisation of the gastrooesophageal junction is pivotal in the endoscopic diagnosis of BO. Multiple ad-hoc grading systems and terminologies of BO have been proposed based on the Z-line appearance, presence or absence of intestinal metaplasia, and the length of Barrett's segment. However, a universally accepted standardised endoscopic grading system of BO is lacking. The Prague C&M criteria, developed by a subgroup of the International Working Group for the Classification of Oesophagitis, are the first explicit, consensus-driven, clinically relevant criteria for the endoscopic recognition and grading of BO that may be useful in both clinical practice and research trials.
Anand
Oksana
O
Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center and The University of Kansas School of Medicine, Kansas City, MO, USA.
Wani
Sachin
S
Sharma
Prateek
P
D001471:Barrett Esophagus / Q000145:classification* / Q000473:pathology; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008679:Metaplasia / Q000473:pathology; D012720:Severity of Illness Index