Prague C&M Criteria for the Endoscopic Grading of Barrett’s Esophagus

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 expert endoscopists with a special interest in BE.

An endoscopic grading system (The Prague C & M Criteria) has been recommended for reporting the extent of Barrett’s esophagus. Measurements should be obtained during withdrawal of the endoscope when the shaft of the endoscope is straight. Distances assessed using centimeter measurements on the shaft of the instrument can be used to measure the distance of landmarks from the incisors more precisely.

• Circumferential extent (C value): Depth of endoscope insertion from the circumferential extent of suspected columnar epithelium.
• Maximum extent (M value): Depth of endoscope insertion from the maximal extent of columnar epithelium.

The Prague criteria have good interobserver reliability for Barrett’s esophagus involving >1 cm of the distal esophagus.

Case report form (CRF) used by assessors for analysis of endoscopic videos

1. Could you identify the diaphragmatic hiatus? If yes, what was the endoscope insertion distance at the diaphragmatic hiatus?	Ο yes   Ο no [………..] cm
2. Could you identify the proximal margin of the gastric fold? If yes, what was the endoscope insertion distance at the proximal ends of the gastric folds?	Ο yes   Ο no [………..] cm
3. Could you identify a circumferential ‘ring’ or ‘pinch’ near the proximal end of the gastric folds? If yes, what was the endoscope insertion distance at this point?	Ο yes   Ο no [………..] cm
4. Was there a circumferential segment of Barrett’s esophagus? If yes, what was the endoscope insertion distance at the proximal margin of the circumferential Barrett’s esophagus?	Ο yes   Ο no [………..] cm
5. Was there at least one tongue-like segment of Barrett’s esophagus? If yes, what was the endoscope insertion distance at the proximal margin of the longest Barrett’s tongue a this point? What portion of the circumference of the esophagus did the tongue occupy?	Ο yes   Ο no [………..] cm Ο <50%    Ο ≥50%
6. With respect to the extent of the Barrett’s esophagus, how would you classify this according to the length from the gastroesophageal junction? Circumferential (C) segment? Maximum extent (M), including tongues?	C [………..] cm M [………..] cm
7. Were there any mucosal breaks identified in the squamous mucosa? If yes, what was the severity of the esophagitis? Please check ( ) one grade. Los Angeles (LA)       Ο Grade A       Ο Grade B       Ο Grade C       Ο Grade D	Ο yes   Ο no
8. Technical adequacy of images. Please check ( ) one number per clip. Ο Not scorable        Ο Poor        Ο Fair        Ο Good        Ο Excellent

 

References:

1. Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, Jankowski JA, Junghard O, Lundell L, Tytgat GN, Vieth M. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006 Nov;131(5):1392-9. [Medline]
2. Alvarez Herrero L, Curvers WL, van Vilsteren FG, Wolfsen H, Ragunath K, Wong Kee Song LM, Mallant-Hent RC, van Oijen A, Scholten P, Schoon EJ, Schenk EB, Weusten BL, Bergman JG. Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice. Endoscopy. 2013 Nov;45(11):876-82. [Medline]
3. Sharma P. Barrett Esophagus: A Review. JAMA. 2022 Aug 16;328(7):663-671. [Medline]

 

Created Aug 25, 2022.