Prague C and M Classification for Barrett's Oesophagus
Standardised endoscopic description of Barrett's oesophagus extent. C = circumferential extent (cm above GOJ); M = maximum extent (cm above GOJ). Used for surveillance interval determination and dysplasia reporting. BSG 2023 and NICE NG12 guidelines use Prague C&M to guide surveillance intervals. Short-segment Barrett's: maximum extent below 3 cm; long-segment: 3 cm or above.
Score interpretation
Prague C and M recorded -- see action for surveillance interval based on length and histology
→ No dysplasia, short-segment (M below 3 cm): surveillance gastroscopy every 3-5 years (BSG 2023); no dysplasia, long-segment (M at least 3 cm): surveillance every 2-3 years; indefinite for dysplasia: high-dose PPI for 8-12 weeks, repeat endoscopy with quadrantic biopsies every 2 cm in specialist Barrett's unit; LGD (confirmed by two GI pathologists): discuss endoscopic eradication therapy (EET) -- radiofrequency ablation (RFA) preferred; HGD or intramucosal carcinoma (T1a): urgent referral to specialist oesophago-gastric MDT for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) if focal lesion, or RFA for flat dysplasia; all Barrett's patients: high-dose PPI (omeprazole 40 mg BD or lansoprazole 30 mg BD) -- reduces dysplasia progression; lifestyle: avoid NSAIDs, reduce alcohol, raise head of bed, weight management; document Prague C&M, histology, and surveillance plan clearly in endoscopy report.
Interpretation bands for the Prague Barrett's. Apply clinical judgement and local guidance.
References
- Sharma P et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C and M criteria. Gastroenterology. 2006;131(5):1392-1399.
- BSG Guidelines for the Diagnosis and Management of Barrett's Oesophagus. British Society of Gastroenterology. 2023.
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Curated clinical cross-links plus same-class fallbacks.
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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.