Prague classification of Barrett’s esophagus
The Prague classification was presented by an international research group in 2006 (1) and has since been regarded as the standard for measuring the length of Barrett’s esophagus. The lower measurement boundary is formed by the proximal cardial notch (optimally with moderate insufflation), and the two upper measurement boundaries are marked by the proximal limit of the circumferential Barrett’s segment (C) and the longest tongue of Barrett’s (M). An error that is often made is to use M to state only the length of the tongue above the circumferential segment, which initially appears logical in the endoscopic report; but M does not measure the length of the tongue, but rather the longest Barrett’s segment (m = maximum), including the longest tongue. M therefore has to be at least as long as C (M ≥ C). In the following illustration, the circumferential segment (C) is 3 cm and the tongue an additional 2 cm, so that M is 5 cm (3 cm circumferential + 2 cm tongue = 5 cm maximum Barrett’s extent, M). The length of the Barrett’s is thus C3M5. A short Barrett’s segment only forming a 1-cm tongue is reported as C0M1. A circular Barrett’s that is 2 cm long without tongues — i.e., with a relatively straight proximal boundary —is reported as C2M2.
- 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: thePrague C & M criteria. Gastroenterology. 2006;131:1392-9. Epub 2006 Aug 16.
- Chang CY, Lee YC, Lee CT, Tu CH, Hwang JC, Chiang H, Tai CM, Chiang TH, Wu MS, Lin JT. The application of Prague C and M criteria in the diagnosis of Barrett’s esophagus in an ethnic Chinese population. Am J Gastroenterol. 2009;104:13-20.
- Vahabzadeh B, Seetharam AB, Cook MB, Wani S, Rastogi A, Bansal A, Early DS, Sharma P. Validation of the Prague C & M criteria for the endoscopic grading of Barrett’s esophagus by gastroenterology trainees: a multicenter study. Gastrointest Endosc. 2012;75:236-41.
- 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;45:876-82. Epub 2013 Oct 28.