Validation of the Prague C & M criteria for the endoscopic grading of Barrett's esophagus by gastroenterology trainees: A multicenter study

Babac Vahabzadeh, Anil B. Seetharam, Michael B. Cook, Sachin Wani, Amit Rastogi, Ajay Bansal, Dayna S. Early, Prateek Sharma

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Background: The Prague C & M criteria, developed for the endoscopic grading of Barrett's esophagus (BE), (C = circumferential length, M = maximal length) were previously validated among a panel of 29 expert endoscopists with a special interest in BE. Its performance among gastroenterology trainees is unknown. Objective: To test interobserver agreement among gastroenterology trainees for the Prague C & M criteria, identification of the gastroesophageal junction (GEJ) and the diaphragmatic hiatus. Design: A prospective study. Setting: Two tertiary referral centers. Patients and Interventions: Standardized endoscopic videos were used. Main Outcome Measurements: Interobserver agreement. Results: Eighteen high-quality videos (normal esophagus, short and long lengths of BE, equally distributed) were independently evaluated by 18 gastroenterology trainees (year 1, n = 5; year 2, n = 6; year 3, n = 7) after administration of a formal teaching module by an expert endoscopist. Overall intraclass correlation coefficients for assessment of the C and M extent of the endoscopic BE segment above the GEJ were 0.94 (95% CI, 0.89-0.98) and 0.96 (95% CI, 0.94-0.98), respectively. The overall intraclass correlation coefficients for GEJ and diaphragmatic hiatus location recognition were 0.92 (0.86-0.96) and 0.90 (0.82-0.95), respectively. The year of training did not affect interobserver agreement. Limitations: The use of videos for endoscopic evaluation. Conclusion: After standardized teaching, the Prague C & M criteria have high overall validity among gastroenterology trainees irrespective of the level of training for endoscopic evaluation of visualized BE lengths as well as key endoscopic landmarks.

Original languageEnglish
Pages (from-to)236-241
Number of pages6
JournalGastrointestinal endoscopy
Issue number2
StatePublished - Feb 2012


  • BE
  • Barrett's esophagus
  • CI
  • EAC
  • GEJ
  • ICC
  • confidence interval
  • esophageal adenocarcinoma
  • gastroesophageal junction
  • intraclass correlation coefficient


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