Both studies used retrospective evaluation of stored still images, an approach that the IWGCO has found inadequate for reliable recognition of landmarks.62 The use of
stored still images introduces another major flaw; Yamagishi et al.58 do not describe the criteria they used, but Akiyama et al.57 used the Prague Criteria, KU-57788 research buy so how could they have arrived at a 43% prevalence of BE? Quite apart from the limitation of identifying landmarks in still images, the endoscopies themselves would not have been done in the way that is needed for adequate application of the Prague Criteria.32 It is almost certain that the position of the gastroesophageal junction was judged to be lower than its true position, because of effacement
of the tops of gastric folds by the routine use of high levels of air distension during endoscopy in Japan. These Japanese studies appear so fatally flawed that their data must be considered invalid. Estimates of the prevalence of BE in reflux disease patients who are referred for endoscopy usually range from 10% to 15% in “Western” countries.2–4 These are mainly reports of endoscopically suspected BE and are probably under-estimates. In the past, especially in the USA, endoscopists have shrunk from recording the presence of “short” segments (usually learn more less than 2 or even 3 cm in length), originally because of uncertainty whether these were really segments of esophageal columnar check details metaplasia and more recently, because of doubts
about their clinical significance, despite acceptance that these were esophageal columnar metaplastic segments. Somewhat paternalistically, it seems to have been thought better not to open what was perceived as a proverbial can of worms. Yet most BE patients have metaplastic segments less than 3 cm long and EA does develop in metaplastic segments even shorter than 1 cm. Given the Prague criteria validation data,32 it is appropriate to identify at least all patients with segments of 1 cm or more so that their EA risk can be determined. If this is not done, we will continue to have no idea about how to advise and manage patients with segments less than 3 cm in extent. Part of this process should be to abandon the ambiguous description “short” and replace it with “C” and “M” values.32 The now well-documented risk that BE carries for development of EA5 is the major concern of clinicians, because they are now expected manage this. Expectations and interest are being driven by the remarkable increase in the incidence of EA in relatively prosperous, mainly Caucasian, populations, albeit from a low base.2–4,53 The complex area of predictors of progression of BE to EA has been reviewed recently.63 Currently, in routine clinical practice, an individual patient’s risk for EA is assessed only crudely by determining if dysplasia is absent or present and if it is present, whether it is of low or high grade.