Specialized intestinal metaplasia is frequently found on biopsies from the squamo-columnar junction. It has been a matter of debate for many years whether this finding and/or columnar lined esophagus (CLE) with a length of up to 1 cm has a clinical significance. Many national society guidelines don’t consider a CLE <1 cm as Barrett’s esophagus (BE) since according to the Prague classification the diagnosis of a BE is not reliable enough. In addition, the risk for malignant progression is highly dependent from the length of the Barrett’s segment. It has been shown that the risk for progression is extremely low in CLE <10 mm and therefore a recommendation for regular surveillance endoscopies wouldn’t be cost effective. As a result, most society guidelines recommend that the diagnosis of BE should only be made in CLE >1 cm and when specialized intestinal metaplasia with goblet cells is confirmed on histopathology.
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