1. The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus The Prague C & M Criteria
Gastroenterology 2006;131:1392~1399
This article is about The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus ,,,The Prague C & M Criteria this article was published at gastroenterology 2006 volume 13.
Prof. 장린 / R3 김석연

2. Background & Aims Barrett’s esophagus (BE) Aims
a premalignant condition for esophageal adenocarcinoma
associated with chronic GERD
its diagnosis relying initially on recognition of a columnar-lined distal esophagus
Salmon-pink in color
Biopsy specimen : intestinal metaplasia
Aims
develop and validate criteria
the endoscopic diagnosis and grading of BE
Barrett’s esophagus (BE) is a premalignant condition for esophageal adenocarcinoma and
associated with chronic gastroesophageal reflux disease.
its diagnosis relying initially on recognition of a columnar-lined distal esophagus.
The columnar linined mucosa of the distal esophagus.
Biopsy specimen reveal intestinal metaplasia
They Aimed to develop and validate explicit, consensus-driven criteria for the endoscopic diagnosis and grading of BE.

3. Material & Methods

4. Working Group Structure and Meetings
A subgroup of the International Working Group for the Classification of Oesophagitis (IWGCO)
Research and clinical interest in BE
The first meeting - September 2002
Strategies for development of criteria for grading
Voting and discussion
A su
All the members of the subclub,which is International Working Group for the Classification of Oesophagitis
have a Research and clinical interest in BE.
The first meeting was convened in September 2002 and Strategies for development of criteria for grading of BE
Through Voting and discussion

5. agreed on criteria and developed materials for
formal evaluation using video-endoscopic recordings gathered in 29 patients
The Criteria
C (circumferential) & M (maximum extent)
Endoscopically visualized BE segment
The working group agreed on criteria and developed materials for their formal evaluation using video-endoscopic recordings gathered in a standardized manner in 29 patients
The criteria included assessment of the circumferential & maximum extent of the Endoscopically visualized BE segment as well as endoscopic landmark

6. FIG 1 is a assessement score sheet for analysis of endoscopy vidieos.

7. M C
C is a extent of circumferential metaplasia, M is maximal extent of the metaplasia.
This figure shows C2M5.

8. C M
Video still of endoscopic barrett`s esophagus showing an area classified as C2M5.

9. Results

10. R C
The RC of Circumferential extent is 0.91, maximal extent 0.66.

11. Table 3 shows the number of video clips with C and M assessments in the relationship to the length of the BE segment.
Almost half of the C assessments but only 5 of the M assessments were less than 0.5cm 29 29

12. R C
The RC of C value were 0.94 C and M was 0.93, representing an “almost perfect”
Also, RC of diaphragmatic hiatus and GEJ were “almost perfect”

13. Table 5 is a percentage agreement for C and M values.
The exact rates of the agreements C and M were 53 percents and 38 percents, respectively.
Whereas the values for agreement within 2 cm were 97%and 95%,respectively.

14. Table 6 is a overall kappa values, based on BE length.
One above 1 cm was 0.72, the other below 1 cm was 0.21.

15. Conclusion The Prague C & M criteria have high
validity for the endoscopic
assessment of visualized BE lengths