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Barrett's oesophagus: size does matter
  1. Pieter J F de Jonge1,
  2. Frederik Hvid-Jensen2
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark
  1. Correspondence to Dr P J F de Jonge, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; p.dejonge{at}erasmusmc.nl

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For several decades, the incidence of oesophageal adenocarcinoma (OAC) has shown the highest proportional rise among all cancers in the Western world. In order to detect neoplasia at a curable stage, endoscopic surveillance of patients with its precursor lesion Barrett's oesophagus (BO) is recommended by various societal guidelines and as such has been widely implemented over the past decades. However, although surveillance endoscopy is intuitively rational, there is currently no proof from randomised trials that this strategy reduces OAC mortality, and its cost-effectiveness has been questioned. The observation that <8% of OAC is preceded by a BO diagnosis further undermines the impact of surveillance. Recent population-based studies have shown a much lower overall cancer risk in BO than previously anticipated, and together with the growing emphasis on healthcare cost containment, the rationale for endoscopic surveillance has come under greater scrutiny.1 ,2 A 2014 cost-utility analysis of current surveillance protocols, incorporating progression estimates from large population-based studies, suggests that surveillance of patients with non-dysplastic BO is unlikely to be cost-effective.3 Alternative strategies such as ablation have raised hope to omit surveillance in patients; however, in reality considerable recurrence rates of both BO and carcinomas in particularly long segment BO (LSBO) still require …

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