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Prague C & M Endoscopic Grading System for BE

Summary and Comment |
March 9, 2007

Prague C & M Endoscopic Grading System for BE

  1. David A. Johnson, MD

Researchers present a validated consensus-based system to standardize grading of Barrett esophagus.

  1. David A. Johnson, MD

No consensus-based guidelines define methods for accurately and reproducibly recognizing and measuring the length of Barrett esophagus (BE), and considerable variation exists within and between observers’ evaluations. A group of international BE experts now present a validated consensus-based system to standardize endoscopic criteria for grading BE.

High-quality digital video recordings of endoscopies in patients with or without BE were used to devise and refine criteria. Concurrently with the digital recording, a numeric display defined the depth of endoscopic insertion (measured from the bite block). Endoscopic criteria were based on anatomic landmarks, with the gastroesophageal junction (GEJ) identified as the proximal margin of the gastric mucosal folds. The BE mucosa was then defined, based on the circumferential extent (C value, in cm) and the maximum extent (M value, in cm) of BE above the GEJ. For example, if BE was circumferential for 2 cm above the GEJ and the maximal extent of non-circumferential BE was 5 cm (i.e., with 3 cm of BE “tongues”) above the GEJ, this would be recorded as C2M5.

The proposed scoring system was validated in an internal study (done by 5 members of the work group) and an external study (22 evaluators) using 29 digital recordings of endoscopies. Internal validation yielded reliability coefficient values of 0.94 for C and 0.88 for M; corresponding values for the external validation were 0.94 and 0.93, respectively. Considering both the C and M criteria, the reliability coefficient (RC) for agreement on the presence of BE >1 cm was high (RC=0.72). However, for BE ≤1 cm, these criteria were much less reliable (RC=0.21).

Comment

A consensus recommendation on, and validation of, an endoscopic grading system is long overdue! This relatively simple grading system for BE extent should be considered the standard for both clinical practice and research trials. Standardized criteria will facilitate more reliable and accurate follow-up and are essential for ensuring accurate reporting on the effects of interventions used in BE patients.

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Reader Comments (1)

harish Fellow-In-Training, Oncology, bengaluru

how does this prague criteria help us in our evaluation for barrets esophagus....if it is c2m5...what exactly does it mean??

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