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Current guidelines suggest adequate surveillance requires 20 biopsies, most of which are normal. A technique that allows restriction of biopsies to abnormal areas would be attractive. The ESS probe passed through an endoscope, pulses light at the tissue and examines the spectrum of reflected light which is sensitive to the density of intracellular organelles. These are increased in dysplasia so ESS can distinguish adenocarcinoma and high grade dysplasia from non-dysplastic tissue (see figure). In this study, 234 matched optical and histological sites were collected from 81 patients. The sensitivity of the ESS was 92% and specificity 60%. The implications of this technique are that the number of biopsies needed per patient would drop from an average of 17 to 8. Furthermore, a negative surveillance performed with the assistance of ESS would have a negative predictive value of >99.5%. The data look impressive but the study needs repeating to see whether
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