© 2003 by Gut
COMMENTARY
Oesophageal disease
S, M, L, XL . . .
Veterans Affairs Medical Center, Stanford University School of Medicine, VA Palo Alto Health Care System, USA
Correspondence to:
Correspondence to:
Professor G Triadafilopoulos, Stanford University School of Medicine, VA Palo Alto Health Care System (111-GI), USA;
vagt@stanford.edu
Methods of surveillance for Barrett’s oesophagus
Keywords: Barrett’s oesophagus; dysplasia; endoscopy; oesophageal adenocarcinoma; imaging
| The first 150 words of the full text of this article appear below. |
Although the early detection of high grade dysplasia, the precursor of oesophageal adenocarcinoma, remains a primary task in the management of patients with Barrett’s oesophagus, several other key end points of screening and surveillance need to be considered (table 1
). As dysplasia is rarely visually recognised during routine fibreoptic or video endoscopy, extensive four quadrant biopsy sampling every 1–2 cm of the entire mucosal surface using jumbo biopsy forceps (Seattle protocol) has been extensively practised, validated, and is currently recommended.1 In a recent report by the pioneers of this approach, the use of this systematic jumbo biopsy protocol every 1 cm in patients with high grade dysplasia who eventually developed cancer, 100% of cancers were detected.2 However, because the technique is labour intensive and requires a therapeutic endoscope, it is used by less than 20% of US gastroenterologists.3 Recently, many strategies and innovative techniques have been developed
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