Criteria

Histologic criteria

  • Barrett esophagus is defined histologically as areas of columnar-lined epithelium in the esophagus cephalad to the gastroesophageal junction. Histologic assessment by experienced pathologists is the standard method of pathologic diagnosis of Barrett esophagus with and without dysplasia.[7] Investigations into increasing accuracy with special pathologic staining, such as cytokeratin stain and biomarkers, have generally been disappointing.[15][42]

  • Areas of carcinoma in situ or invasive carcinoma can exist in Barrett esophagus and are frequently referred to as Barrett cancers.[1][4][43]

Length and dysplasia

Maximal length[44]

  • Short-segment: <3 cm

  • Long-segment: 3 cm or longer.

Degree of dysplasia[4]

  • No dysplasia

  • Indefinite for dysplasia

  • Low-grade dysplasia

  • High-grade dysplasia.

Prague C&M classification[45]

A detailed and reproducible description of the extent of Barrett esophagus visualized during endoscopy is necessary.[7] Current guidelines recommend using the Prague C&M classification, which uses assessment of the circumferential (C) and maximal (M) extent of the endoscopically visualized segment of Barrett esophagus.[7]​[32]​​

In addition, the location of the esophagogastric junction and the diaphragmatic hiatus should be documented in every endoscopy report.

A circumferential segment of Barrett esophagus of 2 cm in length and tongues of intestinal metaplasia extending an additional 3 cm proximally would be classified as C2M5.

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