Rio de Janeiro Global Consensus on Landmarks, Definitions, and Classifications in Barrett's Esophagus: World Endoscopy Organization Delphi Study

Fabian Emura, Viveksandeep Thoguluva Chandrasekar, Cesare Hassan, David Armstrong, Helmut Messmann, Vitor Arantes, Raul Araya, Oscar Barrera-Leon, Jacques J.G.H.M. Bergman, Pradeep Bandhari, Michael J. Bourke, Cecilio Cerisoli, Philip Wai Yan Chiu, Madhav Desai, Mário Dinis-Ribeiro, Gary W. Falk, Mitsuhiro Fujishiro, Srinivas Gaddam, Kenichi Goda, Seth GrossRehan Haidry, Lawrence Ho, Prasad G. Iyer, Sergey Kashin, Shivangi Kothari, Yeong Yeh Lee, Koji Matsuda, Horst Neuhaus, Tsuneo Oyama, Krish Ragunath, Alessandro Repici, Nicholas Shaheen, Rajvinder Singh, Sergio Sobrino-Cossio, Kenneth K. Wang, Irving Waxman, Prateek Sharma

Research output: Contribution to journalArticlepeer-review


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 anatomic 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 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 Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations. Results: After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, 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, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement. Conclusions: We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.

Original languageEnglish (US)
Pages (from-to)84-96.e2
Issue number1
StatePublished - Jul 2022


  • Barrett's esophagus
  • Classifications
  • Definitions
  • Delphi consensus
  • Landmarks
  • Reporting

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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