• Barrett’s oesophagus
• endoscopy

Numerous reviews and guidelines encourage us to undertake surveillance of patients with Barrett’s oesophagus (BO). Despite this, many experienced gastroenterologists consider there is insufficient evidence to support this approach. The definition of what constitutes BO remains an issue and is an important element of critically analysing reports. The previous idea that patients could be selected by the length of the Barret’s segment (>3 cm) appears incorrect as it does not have a major influence on the subsequent risk of carcinoma.¹ The presence of intestinal metaplasia (IM) is important in the pathogenesis of cancer development but the absolute requirement to identify an area of IM before making a diagnosis of BO appears irrational. This is because virtually all patients with a columnar lined oesophagus also have some IM if enough biopsies are taken.²

Depending on the definition, 0.25–2% of the general population have BO.^3,4 The introduction of surveillance for this huge number would therefore have a major impact on NHS finance and endoscopic resources. Most patients in surveillance programmes are initially identified as a result of an endoscopy for a reason other than reflux.⁵ The vast rump of BO therefore remains undetected in the …