Prague C&M and Japanese criteria: shades of Barrett's esophagus endoscopic diagnosis

Abstract

Background: The anatomical reference points used to endoscopically diagnose Barrett's esophagus (BE) differ between Japan and other countries. The esophageal gastric junction (EGJ) is defined as the distal limit of the lower esophageal longitudinal or palisade vessels in Japan, but as the proximal margin of the gastric folds (Prague C&M criteria). The aim of this study was to prospectively compare endoscopic BE diagnoses using the Japanese and Prague C&M criteria.

Methods: Two endoscopists examined 110 consecutive patients [73 male, 37 female; age, 66.5 ± 8.7 (mean ± standard deviation) years]. Post-gastrectomy, post-esophagectomy, and post-chemoradiotherapy esophageal cancer patients were excluded as subjects.

Results: EGJ identification rates were 95% (104/110) and 86% (95/110) using the Japanese and Prague C&M criteria, respectively (p = 0.039). Among the 110 patients, 43 (39%) and 29 (26%) were diagnosed as having endoscopic BE using the respective criteria (p = 0.044). In atrophic gastritis and reflux esophagitis cases, there was no significant difference in EGJ identification rates between the Japanese and Prague C&M criteria. However, the ratio of endoscopic BE diagnosis using the Japanese criteria was significantly higher than that using the Prague C&M criteria in atrophic gastritis cases (p = 0.03).

Conclusions: There was a significant difference in endoscopic BE diagnostic results between the Japanese and Prague C&M criteria. In the Japanese population, the Japanese criteria may be more suitable for the definition of EGJ and for the diagnosis of endoscopic BE than the Prague C&M criteria.