The development and validation of an endoscopic grading system for Barrett's esophagus: The Prague C & M Criteria
The development and validation of an endoscopic grading system for Barrett's esophagus: The Prague C & M Criteria
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DOI：
10.1053/j.gastro.2006.08.032
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发表时间：
2006-11-01
期刊：
影响因子：
29.4
通讯作者：
Vieth, Michael
中科院分区：
文献类型：
--
作者：
Sharma, Prateek;Dent, John;Vieth, Michael
背景和目标：Barrett食管（BE）是食管腺癌的癌前病变，其诊断最初依赖于对食管远端柱状内衬的识别。我们的目的是开发和验证明确的，共识驱动的标准，内镜下诊断和分级的BE.Methods：一个国际工作组商定的标准和开发材料，他们的正式评估使用视频内窥镜记录收集在一个标准化的方式在29例患者。标准包括评估内窥镜下可视化BE段的周向（C）和最大（M）范围以及内窥镜标志。由29名内窥镜医生组成的独立国际小组根据这些标准对记录进行评分。结果：布拉格C & M标准对内镜下BE的识别和程度分级提供了明确的指导。评估胃食管交界处上方内窥镜BE段C & M范围的总体可靠性系数（RC）分别为0.95和0.94。个别患者值的成对比较的精确一致率（C & M值）分别为53%和38%，而2 cm间隔内的一致率分别为97%和95%。内镜识别BE >= 1 cm的总体RC为0.72，而BE < 1 cm的总体RC为0.22。识别胃食管连接部和食管裂孔位置的RC分别为0.88和0.85。结论：布拉格C & M标准对于内镜下评估可视化BE长度具有较高的总体有效性。
Background & Aims: Barrett's esophagus (BE) is a premalignant condition for esophageal adenocarcinoma, its diagnosis relying initially on recognition of a columnar-lined distal esophagus. We aimed to develop and validate explicit, consensus-driven criteria for the endoscopic diagnosis and grading of BE.Methods: An international working group agreed on criteria and developed materials for their formal evaluation using video-endoscopic recordings gathered in a standardized manner in 29 patients. The criteria included assessment of the circumferential (C) and maximum (M) extent of the endoscopically visualized BE segment as well as endoscopic landmarks. The recordings were scored according to these criteria by a separate international panel of 29 endoscopists. Results: The Prague C & M Criteria give explicit guidance on the endoscopic recognition of BE and grading of its extent. The overall reliability coefficients (RC) for the assessment of the C & M extent of the endoscopic BE segment above the gastroesophageal junction were 0.95 and 0.94, respectively. The rates of exact agreement (for C & M values) for pairwise comparisons of individual patient values were 53% and 38%, respectively, whereas the values for agreement within a 2-cm interval were 97% and 95%, respectively. The overall RC for endoscopic recognition of BE >= 1 cm was 0.72, whereas for BE < 1 cm, it was 0.22. The RCs for recognizing the location of the gastroesophageal junction and the diaphragmatic hiatus were 0.88 and 0.85, respectively. Conclusions: The Prague C & M Criteria have high overall validity for the endoscopic assessment of visualized BE lengths.