Table 6.

Ten-step approach to endoscopic examination of Barrett’s esophagus

Approach	Rationale
Identify esophageal landmarks, including the location of the diaphragmatic hiatus, gastroesophageal junction, and squamocolumnar junction	Critical for future examinations
Consider use of a distal attachment cap (especially in patients with prior diagnosis of dysplasia)	Facilitate visualization
Clean mucosa well using water jet channel and carefully suction the fluid	Remove any distracting mucus or debris and minimize mucosal trauma
Use insufflation and desufflation	Fine adjustments to luminal insufflation can help with detection of subtle abnormalities
Spend adequate time inspecting the Barrett’s segment and gastric cardia in retroflexion	Careful examination increases dysplasia detection
Examine the Barrett’s segment using high-definition white light endoscopy	Standard of care
Examine the Barrett’s segment using chromoendoscopy (including virtual chromoendoscopy)	Enhances mucosa pattern and surface vasculature
Use the Prague classification to describe the circumferential and maximal Barrett’s segment length	Standardized reporting system
Use the Paris classification to describe superficial neoplasia	Standardized reporting system
Use the Seattle protocol (in conjunction with electronic chromoendoscopy) with a partially deflated esophagus to sample the Barrett’s segment	Increases dysplasia detection

Adapted from Kolb and Wani (232).