Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice

Lorenza Alvarez Herrero; Wouter L. Curvers; Frederike G. I. van Vilsteren; Herbert Wolfsen; Krish Ragunath; Louis-Michel Wong Kee Song; Rosalie C. Mallant-Hent; Arnoud van Oijen; Pieter Scholten; Erik J. Schoon; Ed B. E. Schenk; Bas L. A. M. Weusten; Jacques G. H. M. Bergman

doi:10.1055/s-0033-1344952

Endoscopy, Table of Contents

Endoscopy 2013; 45(11): 876-882
DOI: 10.1055/s-0033-1344952

Original article

Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice

Lorenza Alvarez Herrero

¹Department of Gastroenterology and Hepatology, St. Antonius hospital, Nieuwegein, The Netherlands

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Wouter L. Curvers

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Frederike G. I. van Vilsteren

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Herbert Wolfsen

³Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

,

Krish Ragunath

⁴Wolfson Digestive Disease Center, Queen’s Medical Center, Nottingham, United Kingdom

,

Louis-Michel Wong Kee Song

⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

,

Rosalie C. Mallant-Hent

⁶Department of Internal Medicine, Flevohospital, Almere, The Netherlands

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Arnoud van Oijen

⁷Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar, The Netherlands

,

Pieter Scholten

⁸Department of Gastroenterology and Hepatology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands

,

Erik J. Schoon

⁹Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands

,

Ed B. E. Schenk

¹⁰Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands

,

Bas L. A. M. Weusten

¹Department of Gastroenterology and Hepatology, St. Antonius hospital, Nieuwegein, The Netherlands

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

Jacques G. H. M. Bergman

²Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Background and study aims: The Prague C&M classification for Barrett’s esophagus has found widespread acceptance but has only been validated by Barrett’s experts scoring video sequences. To date, validation has been lacking for its application in routine practice during real-time endoscopy. The aim of this study was to evaluate agreement between Barrett’s experts and community hospital endoscopists when using this classification to describe Barrett’s esophagus and hiatal hernia length during real-time endoscopy.

Patients and methods: Patients underwent two consecutive endoscopies performed by different endoscopists. The study was performed in two cohorts: one cohort was seen by Barrett’s experts and the other cohort by community hospital endoscopists. Landmarks were recorded according to the Prague classification. Outcomes were interobserver agreement (assessed with intraclass correlation coefficient [ICC]), absolute agreement, and relative agreement.

Results: A total of 187 patients were included, with median extent of C3M5 (IQR C1 – 7 M4 – 9) for Barrett’s esophagus and 3 cm (IQR 2 – 5) for hiatal hernia length. ICC was 0.91 (95 % confidence interval [CI] 0.88 – 0.93) for maximum length, 0.92 (95 %CI 0.90 – 0.94) for circumferential extent, and 0.59 (95 %CI 0.49 – 0.68) for hiatal hernia length. Absolute agreement within ≤ 1 cm was 74 % (95 %CI 68 – 80) for circumference, 68 % (95 %CI 62 – 75) for length, and 63 % (95 %CI 56 – 70) for hiatal hernia length. Relative agreement was 91 % for Barrett’s esophagus and 80 % for hiatal hernia length. Barrett’s experts and community hospital endoscopists showed no differences in agreement. Shorter Barrett’s segments (≤ 5 cm) had lower agreement compared with longer segments (> 5 cm).

Conclusions: Agreement was good for Barrett’s esophagus and reasonable for hiatal hernia length. These findings strengthen the value of the Prague C&M classification to describe Barrett’s esophagus and hiatal hernia length. Although absolute agreement during real-time endoscopy was high, one should anticipate that Barrett’s values may vary by 1 – 2 cm between two endoscopies.

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References

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