组织学标准
Barrett 食管的组织学定义为，胃-食管交界处头侧的食管存在被柱状上皮覆盖的区域。由经验丰富的病理学家进行组织学评估是诊断 Barrett 食管伴或不伴异型增生病理的标准方法。[35]Shaheen NJ, Falk GW, Iyer PG, et al. ACG Clinical Guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol. 2016;111:30-50;quiz 51.https://www.nature.com/ajg/journal/v111/n1/full/ajg2015322a.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/26526079?tool=bestpractice.com[45]Fernando HC, Murthy SC, Hofstetter W, et al; Society of Thoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: guidelines for the management of Barrett's esophagus with high-grade dysplasia. Ann Thorac Surg. 2009;87:1993-2002.http://www.sts.org/sites/default/files/documents/pdf/guidelines/guidelines_highgrade_displaysia.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19463651?tool=bestpractice.com
[Figure caption and citation for the preceding image starts]: Barrett 化生不伴异型增生，表现为胃-食管交界处以上的柱状上皮细胞伴杯状细胞由 Adrian Ormsby 医生（美国密西根州底特律市 Henry Ford 医院）提供 [Citation ends].
[Figure caption and citation for the preceding image starts]: Barrett 化生伴轻度异型增生，注意更不规则的细胞和细胞核由 Adrian Ormsby 医生（美国密西根州底特律市 Henry Ford 医院）提供 [Citation ends].
[Figure caption and citation for the preceding image starts]: Barrett 化生上皮伴高度异型增生。注意更加严重不规则的细胞。由 Adrian Ormsby 医生（美国密西根州底特律市 Henry Ford 医院）提供 [Citation ends].
[Figure caption and citation for the preceding image starts]: Barrett 化生伴高度异型增生，并有一处黏膜内癌病灶。注意恶性细胞突破基底膜侵袭至固有层由 Adrian Ormsby 医生（美国密西根州底特律市 Henry Ford 医院）提供 [Citation ends].使用特殊的病理学染色方法（例细胞角蛋白染色和生物标记物）以增加准确性的探索结果往往都让人失望。[18]Odze RD. Update on the diagnosis and treatment of Barrett esophagus and related neoplastic precursor lesions. Arch Pathol Lab Med. 2008;132:1577-1585.http://www.ncbi.nlm.nih.gov/pubmed/18834215?tool=bestpractice.com[46]Nurgalieva Z, Lowrey A, El-Serag HB. The use of cytokeratin stain to distinguish Barrett's esophagus from contiguous tissues: a systematic review. Dig Dis Sci. 2007;52:1345-1354.http://www.ncbi.nlm.nih.gov/pubmed/17373588?tool=bestpractice.com
Barrett 食管可存在原位癌或浸润性癌，并经常被称为 Barrett 癌症。[1]Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63:7-42.http://gut.bmj.com/content/63/1/7.longhttp://www.ncbi.nlm.nih.gov/pubmed/24165758?tool=bestpractice.com[4]Flejou JF, Svrcek M. Barrett's oesophagus: a pathologist's view. Histopathology. 2007;50:3-14.http://www.ncbi.nlm.nih.gov/pubmed/17204017?tool=bestpractice.com[47]Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop. Gastroenterology. 2004;127:310-330.http://www.gastrojournal.org/article/PIIS0016508504006158/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/15236196?tool=bestpractice.com
长度和异型增生
最大长度[9]Dickman R, Kim JL, Camargo L, et al. Correlation of gastroesophageal reflux disease symptom characteristics with long-segment Barrett's esophagus. Dis Esophagus. 2006;19:360-365.http://www.ncbi.nlm.nih.gov/pubmed/16984533?tool=bestpractice.com
异型增生的程度[4]Flejou JF, Svrcek M. Barrett's oesophagus: a pathologist's view. Histopathology. 2007;50:3-14.http://www.ncbi.nlm.nih.gov/pubmed/17204017?tool=bestpractice.com
无异型增生
不确定的异型增生
轻度异型增生
高度异型增生
布拉格 C&M 分类[48]Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: The Prague C & M criteria. Gastroenterology. 2006;131:1392-1399.http://www.ncbi.nlm.nih.gov/pubmed/17101315?tool=bestpractice.com
有必要对内镜检查时可见的 Barrett 食管范围进行详细和可重现的描述。[35]Shaheen NJ, Falk GW, Iyer PG, et al. ACG Clinical Guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol. 2016;111:30-50;quiz 51.https://www.nature.com/ajg/journal/v111/n1/full/ajg2015322a.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/26526079?tool=bestpractice.com当前的指南推荐使用布拉格 C&M (Prague C&M) 分类，该分类采用对内镜下 Barrett 食管可视节段所累及全周的长度 (C) 和最大长度 (M) 的评估。[34]Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49:191-198.https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0042-122140http://www.ncbi.nlm.nih.gov/pubmed/28122386?tool=bestpractice.com[35]Shaheen NJ, Falk GW, Iyer PG, et al. ACG Clinical Guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol. 2016;111:30-50;quiz 51.https://www.nature.com/ajg/journal/v111/n1/full/ajg2015322a.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/26526079?tool=bestpractice.com
此外，应在每份内镜检查报告中记录胃-食管交界处和膈裂孔的位置。
Barrett 食管累及全周的长度为 2 cm，肠化生在此基础上呈舌状，向近端再延伸 3 cm，这种情况将被分类为 C2M5。
