Prague C & M Classification for Barrett's Esophagus
Stratifies severity of Barrett's esophagus according to endoscopic findings.
Advice
- BE is diagnosed when there is >1 cm of salmon colored mucosa with biopsies revealing intestinal metaplasia.
- If BE is suspected on endoscopy, at least 8 biopsies should be obtained to increase diagnostic yield.
- If nodularity or ulceration is noted, endoscopic mucosal resection should be performed for further classification of underlying pathology.
Management
- Management of BE depends on pathology findings:
- Nondysplastic BE: Repeat EGD in 3-5 years.
- Indefinite for dysplasia: Optimize PPI therapy, repeat EGD with biopsies.
- Low or High Grade Dysplasia: Endoscopic Eradiation Therapy (radiofrequency ablation).
- Esophageal Cancer: Endoscopic Eradication Therapy and/or referral to oncology depending on staging.
- After endoscopic complete eradication of intestinal metaplasia, surveillance EGDs are as follows:
- Intramucosal Carcinoma or High Grade Dysplasia: EGD every 3 months for 1st year, every 6 months for 2nd year, and annually thereafter.
- Low Grade Dysplasia: EGD every 6 months for 1st year, and annually thereafter.
- Regardless of pathology, all patients with BE should be placed on proton pump inhibitors until symptom relief is attained.