ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand) | 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

In this video, the speaker discusses the classification and measurement of Barrett's esophagus, a condition where the lining of the esophagus changes. It was previously believed that only the long segment of Barrett's esophagus led to cancer, but this is now known to be false. The video explains the confusion in accurately measuring the extent of Barrett's esophagus, especially when "tongues" of Barrett's mucosa are present. The Prague C and M classification, proposed in 2004, attempts to standardize measurements. The video includes an illustration that clarifies the classification, and provides an example of how to measure and classify Barrett's esophagus using the Prague system. Islands of Barrett's esophagus are not considered in this classification.

Keywords

Barrett's esophagus

classification

measurement

lining changes

Prague C and M classification