Sa1894 Enhanced Characterization of Barrett's Esophagus Islands Through a Revision of the Prague Criteria

Abstract

Background: Barrett's esophagus (BE) is a premalignant condition that can progress to adenocarcinoma of the esophagus and gastroesophageal junction. The Prague and criteria was established to provide guidelines on the endoscopic characterization of BE through grading of continuous metaplastic extension from the top of the gastric folds. However, we have observed BE patients with metaplastic columnar ‘islands' that would not be classified under the current criteria. The possibility of dysplasia within these islands and the potential for missed lesions during surveillance or through ablative therapy highlights the need for a revision of the Prague criteria. Aim: To identify and characterize Barrett's esophagus patients that develop metaplastic columnar islands and to assess the utility of a descriptive tool used in addition to the Prague criteria Methods: This retrospective review analyzed consecutive patients with BE referred for management of suspected dysplasia. All patients were assessed with endoscopes equipped with high definition white light, and narrow band imaging. All cases were classified using the Prague criteria for BE at a baseline, mapping upper endoscopy with 4 quadrant biopsies taken at 1 cm intervals from the gastroesophageal junction. After the C and M of the Prague scale were recorded, all additional islands of metaplastic columnar mucosa were mapped. An designation was given to the most proximal island measured from the gastroesophageal junction. The Barrett's segment was represented as a CxMxIx where x is the number in cm from the gastroesophageal junction. Biopsied tissue was assessed for dysplasia, which was confirmed by an expert GI pathologist. Patients with and without islands were compared. Results: From June 2012 to October 2014, 73 patients (mean age 66.0, 61male, 12 female) were referred for assessment of potential dysplastic BE. 49 (67%) patients did not have any observed islands (mean age 67.4, range 19-87). 25 (33%) patients (mean age 63.6, range 37-84) had islands of Barrett's tissue; 11 with de novo islands and 14 with islands appearing after endoscopic ablation was administered. In the non-island BE group, the mean and range of and were 3.3 (011) and 4.8 (1-12) respectively. In the BE group with islands, the mean and range of C, and I were 2.5 (0-11), 3.5 (0-10) and 5.2(1-10) respectively. 2 patients in the island BE group had biopsy confirmed intramucosal carcinoma. All patients had regular surveillance with or without ablative therapy. Conclusion: The Prague criteria is well validated for endoscopic description of BE. However, we have observed that many patients assessed for BE have island configurations of Barrett's tissue that fall outside of classic Prague descriptors. The potential risk of missed dysplastic lesions warrants the need for a revision to the Prague Criteria.