Upper gastrointestinal endoscopy: evolving classification tools
Gastroenterology and Hepatology from Bed to Bench,
Vol. 18 No. 3 (2025),
26 August 2025
https://doi.org/10.22037/ghfbb.v18i3.3166
Abstract
Gastrointestinal (GI) endoscopy is a fundamental tool for diagnosing and managing digestive diseases. Standardized classification systems have enhanced the consistency, accuracy, and clinical decision-making in endoscopic evaluation. This review explores key classification systems, their applications, and challenges in their implementation (1).
A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar, Medline, and ClinicalTrials.gov. Relevant classification systems for upper GI endoscopy were categorized based on anatomical regions and adverse event reporting. Artificial intelligence (AI)-assisted tools were used to refine descriptions of classification criteria, and a structured figure was developed to visually represent these classifications.
Major classification systems reviewed include the Los Angeles Classification (2) for reflux esophagitis, Prague Classification (3) for Barrett’s esophagus, and the Forrest Classification (4) for peptic ulcer disease. The AGREE Classification (5) was highlighted for its role in adverse event reporting. Advances in high-definition imaging and narrow-band imaging (NBI) (6) have refined these classifications, improving diagnostic precision. However, practical challenges remain, including the complexity of these systems and the need for continuous education among endoscopists (7).
Endoscopic classification systems play a crucial role in standardizing the assessment of GI diseases, improving diagnostic accuracy, treatment decisions, and communication among clinicians. As these classifications evolve, their continued refinement and integration into clinical practice will enhance their utility, ensuring consistency in endoscopic evaluations and better patient outcomes.
- Upper gastrointestinal tract endoscopy
- classification system
- Upper gastrointestinal diseases
How to Cite
References
Beg S, Ragunath K, Wyman A, Banks M, Trudgill N, Pritchard MD, et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017;66:1886–99.
Lundell L, Dent J, Bennett J, Blum A, Armstrong D, Galmiche J, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172–80.
Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, et al. Development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006;131:1392–9.
Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;2:394-7.
Nass KJ, Zwager LW, van der Vlugt M, Dekker E, Bossuyt PM, Ravindran S, et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022;95:1078-85. e8.
Hamamoto Y, Endo T, Nosho K, Arimura Y, Sato M, Imai K. Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett’s esophagus. J Gastroenterol 2004;39:14–20.
East JE, Vleugels JL, Roelandt P, Bhandari P, Bisschops R, Dekker E, et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 2016;48:1029-45.
Liedlgruber M, Uhl A. Computer-aided decision support systems for endoscopy in the gastrointestinal tract: a review. IEEE Rev Biomed Eng 2011;4:73–88.
Khan R, Gimpaya N, Vargas JI, Ramkissoon A, Seleq S, Gholami R, et al. The Toronto upper gastrointestinal cleaning score: a prospective validation study. Endoscopy 2023;55:121–8.
Córdova H, Barreiro-Alonso E, Castillo-Regalado E, Cubiella J, Delgado-Guillena P, Redondo PD, et al. Applicability of the Barcelona scale to assess the mucosal cleanliness at esophagogastroduodenoscopy. Gastroenterol Hepatol 2024;47:246–52.
Romańczyk M, Ostrowski B, Kozłowska‐Petriczko K, Pawlak KM, Kurek K, Zatorski H, et al. Scoring system assessing mucosal visibility of upper gastrointestinal tract: the POLPREP scale. J Gastroenterol Hepatol 2022;37:164–8.
Wong V. Assessing the safety of discontinuing non-selective beta-blockers in cirrhotic patients with managed primary aetiological factors according to Baveno VII consensus. 2023.
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20. e6.
Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991;37:165-9.
Kodsi BE, Wickremesinghe PC, Kozinn PJ, Iswara K, Goldberg PK. Candida esophagitis: a prospective study of 27 cases. Gastroenterology 1976;71:715-9.
García-Peraza-Herrera LC, Everson M, Lovat L, Wang H-P, Wang WL, Haidry R, et al. Intrapapillary capillary loop classification in magnification endoscopy: open dataset and baseline methodology. Int J Comput Assist Radiol Surg 2020;15:651-9.
Tan JL, Singh R. Esophagus: The BING Classification. In: Atlas of Advanced Endoscopy. Springer; 2024. p. 55–9.
Inoue H, Kaga M, Ikeda H, Sato C, Sato H, Minami H, et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol 2015;28:41.
Hosokawa Y, Kinoshita T, Konishi M, Takahashi S, Gotohda N, Kato Y, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol 2012;19:677-83.
Group NECR. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005;37:570-8.
Schaible A, Schmidt T, Diener M, Hinz U, Sauer P, Wichmann D, et al. [Intrathoracic anastomotic leakage following esophageal and cardial resection: definition and validation of a new severity grading classification]. Chirurg 2018;89:945-51.
Hill LD, Kozarek RA. The gastroesophageal flap valve. J Clin Gastroenterol 1999;28:194-7.
Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification, and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343-9.
Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015;64:1353-67.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161-81.
Esposito G, Pimentel-Nunes P, Angeletti S, Castro R, Libânio D, Galli G, et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 2019;51:515-21.
Yao K, Anagnostopoulos G, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 2009;41:462-7.
Borrmann R. Geschwülste des Magens und Duodenums. Verdauungsschlauch: Erster Teil Rachen und Tonsillen· Speiseröhre· Magen und Darm· Bauchfell 1926:812-1054.
Spigelman A, Talbot I, Williams C, Domizio P, Phillips R. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989;334:783-5.
Reflux Esophagitis: Los Angeles Classification. Available at: https://www.endoscopy-campus.com/en/classifications/reflux-esophagitis-los-angeles-classification/
Kodsi Classification of Candida Esophagitis. Available at: https://www.endoscopy-campus.com/en/classifications/kodsi-classification-of-candida-esophagitis/
Prague Classification for Barrett's Esophagus. Available at: https://www.endoscopy-campus.com/en/classifications/prague-classification-barrett-esophagus/
Paris Classification for Early Barrett Cancers. Available at: https://www.endoscopy-campus.com/en/classifications/paris-classification-early-barrett-cancers/
Esophagogastric Junction Cancers (AEG). Available at: https://www.endoscopy-campus.com/en/classifications/esophagastric-junction-cancers-aeg/
Fundic Varices Classification. Available at: https://www.endoscopy-campus.com/en/classifications/fundic-varices/
Sydney Classification for Assessment of Deep Mural Injury. Available at: https://www.endoscopy-campus.com/en/classifications/sydney-classification-assessment-of-deep-mural-injury-after-endoscopic-mucosal-resection/
Kodsi Classification for Candida Esophagitis. Available at: https://www.endoscopy-campus.com/en/classifications/kodsi-classification-of-candida-esophagitis/
Endoscopic Reference Score Fact Sheet. Available at: https://www.bms.com/assets/bms/us/en-us/pdf/endoscopic-reference-score-fact-sheet.pdf
Validation of the Endoscopic Part of the Spigelman Classification. Available at: https://journals.lww.com/ajg/fulltext/2022/02000/validation_of_the_endoscopic_part_of_the_spigelman.27.aspx
Paris Classification of Polypoid Lesions. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750452/
Thieme Connect: Modern Techniques in Endoscopy. Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-0808-3186.pdf
Endoscopic Techniques for Rectal Cancer Management. Available at: https://drive.google.com/file/d/1fYEKWCCRrT7jz9Fj3JMVNN1N82M5IjJy/view
Prague Classification for Barrett's Esophagus. Available at: https://www.endoscopy-campus.com/en/classifications/prague-classification-barrett-esophagus/
Barrett's Cancer Classification. Available at: https://www.endoscopy-campus.com/en/classifications/paris-classification-early-barrett-cancers/
Endoscopic Innovations in Gastroenterology. Available at: https://journals.lww.com/ajg/fulltext/2022/02000/validation_of_the_endoscopic_part_of_the_spigelman.27.aspx
Los Angeles Classification of Esophagitis. Available at: https://www.endoscopy-campus.com/en/classifications/reflux-esophagitis-los-angeles-classification/
Fundic Varices and Endoscopic Classification. Available at: https://www.endoscopy-campus.com/en/classifications/fundic-varices/
Deep Mural Injury Assessment Techniques. Available at: https://www.endoscopy-campus.com/en/classifications/sydney-classification-assessment-of-deep-mural-injury-after-endoscopic-mucosal-resection/
Esophagogastric Junction Cancer Classification. Available at: https://www.endoscopy-campus.com/en/classifications/esophagastric-junction-cancers-aeg/
Thieme Advanced Endoscopic Research. Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-0808-3186.pdf
Polypoid Lesions Classification. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750452/
Advanced Endoscopic Classification Techniques. Available at: https://journals.lww.com/ajg/fulltext/2022/02000/validation_of_the_endoscopic_part_of_the_spigelman.27.aspx
Esophageal Anastomoses Insufficiency Classification. Available at: https://www.endoscopy-campus.com/en/classifications/die-caes-klassifikation-der-oesophagusanastomosen-insuffizienz/
Thieme Innovations in Endoscopic Practices. Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-0808-3186.pdf
Barrett's Esophagus and Advanced Classifications. Available at: https://www.endoscopy-campus.com/en/classifications/paris-classification-early-barrett-cancers/
Esophageal Cancer Advances in Classification. Available at: https://www.endoscopy-campus.com/en/classifications/esophagastric-junction-cancers-aeg/
Reference Scoring Techniques in Endoscopy. Available at: https://www.bms.com/assets/bms/us/en-us/pdf/endoscopic-reference-score-fact-sheet.pdf
Barrett Esophagus Classifications. Available at: https://www.endoscopy-campus.com/en/classifications/prague-classification-barrett-esophagus/
Kodsi Candida Esophagitis Studies. Available at: https://www.endoscopy-campus.com/en/classifications/kodsi-classification-of-candida-esophagitis/
Advanced Paris Classification Polypoid Lesions. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750452/
Validation Studies of Spigelman Classification. Available at: https://journals.lww.com/ajg/fulltext/2022/02000/validation_of_the_endoscopic_part_of_the_spigelman.27.aspx
Endoscopic Assessment of Fundic Varices. Available at: https://www.endoscopy-campus.com/en/classifications/fundic-varices/
Alagappan M, Brown JRG, Mori Y, Berzin TM. Artificial intelligence in gastrointestinal endoscopy: The future is almost here. World J Gastrointest Endosc 2018;10:239.
Ahmed Z, Mohamed K, Zeeshan S, Dong X. Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine. Database 2020;2020:baaa010.
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