Background The Prague C & M Criteria, developed for the endoscopic grading of Barrett's esophagus (BE), (C=circumferential length, M=maximal length) were previously validated among a panel of 30 expert endoscopists with a special interest in BE. Its performance among gastroenterology (GI) trainees is unknown. Objective To test inter-observer agreement among GI trainees for the Prague C & M criteria, identification of the gastroesophageal junction (GEJ) and the diaphragmatic hiatus. Design A prospective study. Setting Two tertiary-referral centers. Patients and Interventions Standardized endoscopic videos were used. Main Outcome Measurements Inter-observer agreement Results 18 high quality videos (normal esophagus, short and long lengths of BE: equally distributed) were independently evaluated by 18 GI trainees [Year 1 (5), Year 2 (6), Year 3 (7)] after administration of a formal teaching module by an expert endoscopist. Overall intraclass correlation coefficients (ICC) for assessment of the C & M extent of the endoscopic BE segment above the GEJ were 0.94 (0.89-0.98) and 0.96 (0.94-0.98), respectively. The overall ICC for GEJ and diaphragmatic hiatus location recognition were 0.92 (0.86-0.96) and 0.90 (0.82-0.95) respectively. The year of training did not affect inter-observer agreement. Limitations The use of videos for endoscopic evaluation. Conclusion After standardized teaching, the Prague C&M criteria have high overall validity among gastroenterology trainees irrespective of the level of training for endoscopic evaluation of visualized BE lengths as well as key endoscopic landmarks.

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