Use of Prague Classification as a Quality Measure in the Management of Barrettʼs Esophagus

Abstract

Introduction: The Prague classification is a validated system published in November 2006 that relies on the visual description of the circumference and maximal extent of BE. It has been shown to have high reliability coefficients (RCs) for recognition of BE and has been linked to outcomes with endoscopic therapy. Since the use of the Prague C and M classification has been suggested as a possible quality metric for BE patients undergoing endoscopy, our aim was to assess the compliance in the use of the Prague classification in the endoscopic evaluation of Barrett's patients. Methods: Using a large multi-center cohort database of BE patients, the EGD records between 2007-2016 of patients from 3 tertiary referral centers were analyzed. Patient demographics and Prague classification were recorded. Chi-square testing was used to determine significant differences in use over time. Results: Of 10,567 EGD procedures, we analyzed 2,419 procedures performed between 2007-2016. Of the 2,419 EGDs, only 955 (39%) reported Prague Classification. A significant increase in the trend of reporting was observed between 2007 and 2016 from 29% to 42% respectively (p < 0.001) (Graph 1). Among the various predictors evaluated with the use of the Prague classification, patient age (p=0.51), sex (p=0.14), length of BE (p=0.88) and histology (p=0.31), were not associated with its use. Only the year proved to be significant; with each year, the Prague Classification was more likely to be used (p < 0.001). Conclusion: The use of the Prague classification is low even among tertiary care centers with < 50% use during endoscopy. There has been a steady increase in its use since 2007. This suggests that more education and training may be needed in this area as the focus on quality of endoscopy in BE becomes mainstream.Figure: Reporting of Prague Classification in BE Patients between 2007-2016 (Trend p<0.001).