ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Endoscopic Classification of Barrett’s Esophagus

Video Transcription

The short segment Barrett's is less than 3 cm and the long segment greater than 3 cm in length.  This classification was proposed as it was believed that only the long segment Barrett's progressed to adenocarcinoma, which we now know is not true.  These images show short and long segment Barrett's esophagus. The distances are measured from top of gastric folds.  This classification, although simple, is subject to some confusion regarding the true extent of Barrett's esophagus, especially when tongues of Barrett's mucosa are present.  So in this example, if a tongue of Barrett's mucosa is present, should the length of Barrett's mucosa be measured as 2 cm or 4 cm and is the Barrett's esophagus short segment or  long segment? Prague C and M classification was proposed at the 2004 United European Gastroenterology Week meeting in Prague, Czech Republic.  This was an attempt to standardize and more accurately measure Barrett's esophagus. The C stands for endoscopic insertion for the gastroesophageal junction minus proximal  margin of the circumferential Barrett's epithelium. M is the endoscopic insertion distance for gastroesophageal junction minus proximal margin  of the longest tongue-like segment of Barrett's epithelium. This illustration explains the Prague classification more clearly. The area in red represents Barrett's esophagus.  The gastric folds are shown by the irregular black line. The scale shows the depth of endoscopic insertion measured from the incisors. The top of gastric folds is at 38 cm.  The proximal extent of circumferential Barrett's at 36 cm. The proximal margin of the longest tongue of Barrett's extends up to 32 cm.  So the circumferential length is 2 cm and the maximum length is 6 cm, making the Prague classification P2M6.  Note that the M is the total length of Barrett's esophagus from the top of gastric folds and not just the length of the tongues.  Islands of Barrett's esophagus if seen are not considered in this classification. So in an earlier example, the Barrett's esophagus will be classified as C2M4.

Video Summary

The video segment discusses the classification and measurement of Barrett's esophagus. It explains that short Barrett's is less than 3 cm in length, while long Barrett's is greater than 3 cm. However, it is now known that both types can progress to adenocarcinoma. The Prague C and M classification, proposed at a gastroenterology meeting in Prague, was designed to standardize and improve measurement accuracy. The C represents the distance from the gastroesophageal junction to the proximal margin of the circumferential Barrett's epithelium, while the M represents the distance to the longest tongue-like segment. The video provides an illustration to clarify the classification, explaining that the M measurement includes the entire length of Barrett's esophagus. Islands of Barrett's esophagus are not considered in this classification. An example is given, showing a P2M6 classification for a case with a circumferential length of 2 cm and a maximum length of 6 cm. Previously discussed, the example would be classified as C2M4. No credits were given in the video.

Keywords

Barrett's esophagus

classification

measurement

short Barrett's

long Barrett's