The main statements of the current recommendations of the World Endoscopy Organization on the diagnosis and management of patients with Barrett’s esophagus

This article summarizes current standards for the diagnosis of Barrett’s esophagus and the management of affected patients, as developed and published by the expert panel of the Esophageal Diseases Committee of the World Endoscopy Organization. The panel aimed to formulate updated, evidence-based recommendations; to provide a precise description of the key anatomical landmarks relevant to the diagnosis of esophageal pathology; and to facilitate their consistent use in standardized endoscopic reporting. Particular emphasis is placed on improving the endoscopic diagnosis of precancerous lesions and early esophageal cancer. From both endoscopic and histopathological perspectives, Barrett’s esophagus is defined as a segment of columnar metaplastic epithelium in the distal esophagus, measuring at least 1 cm in length, that is identified endoscopically proximal to the esophagogastric junction and confirmed histologically by examination of biopsy specimens. Current clinical guidelines in most countries require histological confirmation of intestinal-type metaplasia of the esophageal mucosa to establish a diagnosis of Barrett’s esophagus, as this is the only type of columnar epithelium associated with an increased risk of malignant transformation. Areas of columnar epithelium with intestinal metaplasia measuring less than 1 cm, located in the gastric cardia or appearing as “tongues” of columnar epithelium at an irregular squamocolumnar junction, are not associated with an increased risk of esophageal adenocarcinoma and are classified as foci of intestinal metaplasia of the esophagogastric junction. The importance of studying and refining diagnostic and therapeutic strategies for Barrett’s esophagus is evident, given the rising incidence of esophageal adenocarcinoma in developed countries and the high mortality associated with this malignancy. Despite substantial progress in the diagnosis and treatment of Barrett’s esophagus, standardized definitions, accurate recognition of endoscopic landmarks, and consistent application of classification systems remain essential. Persisting inconsistencies in the core definitions of Barrett’s esophagus, together with insufficient awareness and understanding of relevant anatomical landmarks, continue to hinder uniformity in endoscopic medical documentation. Following a comprehensive review of this condition, the World Endoscopy Organization expert panel reached consensus on six key endoscopic landmarks for the assessment of Barrett’s esophagus. These include the palisade vessels, the esophagogastric junction (EGJ), the squamocolumnar junction, or Z-line, the location of the lesion, extrinsic compression of the esophageal wall by adjacent organs and vessels, and orientation of the endoscopic image by quadrants, corresponding to quarters of the esophageal circumference. The panel also defined 13 key terms: Barrett’s esophagus, hiatal hernia, squamous islands, columnar metaplastic islands, complete endoscopic resection, endoscopic resection, endoscopic ablation, systematic inspection protocol, complete eradication of intestinal metaplasia and dysplasia, residual foci, recurrence of areas of columnar metaplasia, and failed endoscopic treatment. Four principal classification systems were identified for describing Barrett’s esophagus and manifestations of reflux disease: the Prague classification, the Los Angeles classification, the Paris classification, and the classification proposed by the Barrett’s International NBI Group (BING; NBI, narrow-band imaging). Thus, the World Endoscopy Organization expert panel has outlined the key provisions of the updated recommendations, including endoscopic anatomical landmarks, definitions, and classification systems used in the diagnosis and description of Barrett’s esophagus. These evidence-based recommendations are intended to improve the quality of diagnosis and endoscopic assessment of Barrett’s esophagus, a condition regarded as the only facultative precancerous disorder characterized by multistep neoplastic progression. Implementation of these standards may support more accurate diagnosis and promote uniform endoscopic reporting of Barrett’s esophagus across healthcare institutions.