This ASG video tip is sponsored by Braintree, maker of the newly approved Souflave and SUTAB. And of course, we should always be thinking in patients with known Barrett's, think about the Prague classification, which is another standardized way of reporting Barrett's length. And I'm sure a lot of us have heard about this. And indeed it is, it is a sequential process where we identify the landmarks, we identify the diaphragmatic hiatus, we identify the GE junction, we identify the squamous columnar junction, and then we measure the circumferential extent of the Barrett's mucosa. We then measure the maximal extent of the Barrett's mucosa, and then report this as a C number and an M number, with the C being a measure of the circumferential extent and the M being a measure of the maximal extent. Just a quick example here. So again, we have the GE junction right here. So we are measuring the C length to the point where we have circumferential Barrett's, and then we have the M length to the point where we have the most proximal displacement of the squamous columnar junction. Now islands of note are not really included in the Prague classification, and you can make a separate comment, but really this includes contiguous segments of columnar metaplasia from the GE junction. Another example. So this is the GE junction labeled as the black circle. And then you have this, let's say that this is located at 40 centimeters, and then the first measurement is where the circumferential Barrett's ends, and that is at 39 centimeters. So that leads to C1. And then you have the maximal extent going up to 36 centimeters, and that would be M4. So in this instance, you can, in a very standardized fashion, you can report not only the maximal extent, but also the circumferential extent. Again, what should we be reporting? If we see any Barrett's, we should be reporting the Barrett segment length in the form of the Prague criteria. We should be reporting the presence of any visible abnormality at what centimeters from the esophagus, what is the size, and what is the o-cloth, if you can think of the esophagus cross-section as a cloth. Always document the presence and size of a hiatal hernia, and always document the presence of any esophagitis either above the Barrett segment, or even if you don't have Barrett's, you should still be reporting the esophagitis as a standardized terminology so that anyone who reads the report should be able to understand the findings.

Prague classification

Barrett's mucosa

diaphragmatic hiatus

GE junction

squamous columnar junction