Validation of the Prague C & M criteria for the endoscopic grading of Barrett's esophagus by gastroenterology trainees: a multicenter study

Abstract

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.

Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma in Spain. A unicentric study

“…Regarding BE length, as most of the results were obtained prior to the establishment of the Prague criteria (C, circumferential extent, and M, maximum extent) (22,23), BE was measured in centimeters, counting from the esophageal gastric junction (EGJ) to the proximal section of the squamocolumnar junction hence distinguishing short BE (< 3 cm) from long BE (> 3 cm). Once these data were obtained for each group, a multivariate comparison analysis was carried out, with the purpose of determining possible risk factors with an influence on the histopathological behavior of BE and EAC.…”

Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative

“…The score has been validated among experts 18 and in two additional studies among trainees and community-based endoscopists, strengthening the value of the Prague classification for the accurate description of Barrett's esophagus and the length of the hiatal hernia. 27,28 The ESGE guideline on the diagnosis and management of nonvariceal UGI bleeding has strongly recommended the uniform use of the Forrest classification, as used in several studies assessing the risk for peptic ulcer bleeding and rebleeding. 29,30 Therefore it is clinically important that this classification is used in the endoscopy report in order to ascertain the correct clinical management after endoscopy for UGI bleeds.…”

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

“…The clinical diagnosis is based on the endoscopic recognition of red/pink gastric-like mucosa lining the tubular esophagus above the EGJ, which is defined as the most proximal margins of the gastric folds in the West (the Prague C & M criteria) [10][11][12] and as the lower end of the palisade vessels of the lower esophagus in Japan (the Japanese criteria) [13][14][15]. In patients with severe atrophic gastritis, particularly Asian and Japanese individuals with Helicobacter pylori, the infection-which spreads through the cardia from the antrum-atrophic gastritis-makes it difficult for the oral end of the gastric folds to be used as a marker of the EGJ.…”

“…The overall reliability coefficients for the endoscopic recognition of BE C1 cm was 0.72, whereas for the endoscopic recognition of BE \1 cm of columnarlined epithelium (CLE), the coefficient was only 0.22 [12]. One possible reason for the difficulty may be the use of a different definition of the EGJ as discussed above [10][11][12][13][14][15]. In studies based in the USA, only cases in which SIM was histologically confirmed in CLE were defined as BE, of any length.…”