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Oesophagus
The prague C & M criteria for grading barrett's oesophagus: a live endoscopy evaluation of observer agreement
  1. J Shutt *1,
  2. D Chan2,
  3. C Boger3,
  4. P Patel2
  1. 1Gastroenterology, Dorset County Hospital Foundation Trust, Dorchester, UK
  2. 2Gastroenterology, Southampton University Hospital Trust, Southampton, UK
  3. 3Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK

Abstract

Introduction To validate the Prague C and M criteria for the endoscopic diagnosis and grading of Barrett's oesophagus (BO) in a real-time clinical setting between two experienced endoscopists in a University teaching hospital in the UK.

Methods Forty consecutive cases with BO were studied. A nurse endoscopist applied the Prague C and M criteria to record the Circumferential and Maximal extent of BO on push and pull endoscopy, this was repeated on pull endoscopy by a doctor (blinded to the initial assessment, with the nurse endoscopist not present). Landmark measurements were recorded by an independent observer. Intra- and inter-rater agreement regarding the length of C and M was evaluated by the correlation coefficient and Bland-Altman analysis.

Results The Pearson correlation coefficients (r) for nurse pull against push endoscopy were 0.89 for C and 0.87 for M (p<0.001), and for doctor against nurse were 0.76 for C and 0.80 for M (p<0.001). Comparing pull against push endoscopy, the exact rates of agreement were 15/40 and 12/40 for C and M respectively, differing by 1 cm in 30/40 and 27/40, and by 2 cm in 30/40 and 36/40 respectively. There were 5 and 4 cases with differences of 3 or 4 cm for C and M respectively. Comparing doctor against nurse, the exact rates of agreement were 8/40 and 6/40 for C and M respectively, differing by 1 cm in 20/40 and 21/40, and by 2 cm in 30/40 and 29/40 respectively. There were 9 and 11 cases with differences of 3 or 4 cm for C and M respectively, and 1 case where C differed by 5 cm. From the Bland-Altman analysis, the mean difference in C between pull and push endoscopy was 0.33 cm (95% CI −0.22 to 2.00), with limits of agreement from −2.59 to 3.24 cm. For M, the mean difference between pull and push endoscopy was 0.63 cm (95% CI 0.07 to 2.03), with limits of agreement from −2.33 to 3.58 cm. The mean difference in C between doctor and nurse was −0.03 cm (95% CI −0.82 to 2.94), with limits of agreement from −4.31 to 4.26 cm. For M the mean difference between doctor and nurse was −0.33 cm (95% CI −1.09 to 2.81), with limits of agreement from −4.41 to 3.76 cm.

Conclusion There was good agreement for interobserver C and M values of BO at live endoscopy, but with clinically significant limits of agreement that must be considered in any studies that use the Prague criteria, especially in trials that report a reduction in the length of BO as an end point. In this real-time clinical setting, patient movement and retching, compounded by the lack of 1 cm markings on the endoscope may well have contributed to this reduced degree of agreement.

  • Barrett's oesophagus
  • Endoscopic Classification
  • Prague C and M

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Footnotes

  • Competing interests None.

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