First Level Endoscopy in Barrett’s Esophagus: Endoscopic Pictures, Praga Classification, and Biopsy Protocols

  • Massimo Conio
  • Antonella De Ceglie
  • Mattia Crespi


Barrett’s esophagus (BE) should only be diagnosed when there is a clearly endoscopically visible change from squamous to columnar epithelium in the distal esophagus, starting at gastro-esophageal junction.

During index endoscopy when BE is suspected or in known BE endoscopic surveillance, a careful inspection of the BE mucosa is recommended, using high-resolution endoscopes.

Endoscopic characteristic of the metaplastic epithelium must be described according to the Praga C&M criteria, reporting the site of the landmarks and the presence and location of visible lesions according to the Paris classification. The Seattle biopsy protocol and target biopsy samples from visible lesions are recommended at the time of diagnosis and at subsequent surveillance.

The development of advanced endoscopic imaging techniques that increase the detection of both intestinal metaplasia and dysplasia in BE has been the focus of intense research.


Barrett’ esophagus Praga C&M criteria Seattle protocol High-resolution endoscopes Chromoendoscopy 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Massimo Conio
    • 1
  • Antonella De Ceglie
    • 1
  • Mattia Crespi
    • 1
  1. 1.Department of GastroenterologyGeneral HospitalSanremoItaly

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