LAUSR

BACKGROUND & AIMS Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomical knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application. METHODS The World Endoscopy Organization (WEO) Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the GRADE tool to assess the quality of evidence and the strength of recommendations. RESULTS After three rounds of voting, experts achieved consensus on six endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesions' location, extraluminal compressions and quadrant orientation), thirteen definitions (Barrett's esophagus, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, failure of endoscopic therapy) and four classification systems (Prague, Los Angeles, Paris and BING). In round one, 18 (78%) of statements reached consensus, with 12 (67%) of these statements receiving strong agreement from more than half of experts. In round 2, 4 (80%) of the remaining statements reached consensus, with one statement receiving strong agreement from 50% of experts. In the third round, a consensus was reached on the remaining statement. CONCLUSION We have developed evidence-based consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.