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I propose that a patient with a clinical diagnosis of Barrett’s oesophagus (BO) must have regularly endoscopic surveillance and protocol biopsy. BO is defined by endoscopically visible oesophageal columnar epithelium with intestinal metaplasia. The purpose of screening is detection of dysplastic change and early cancer, to allow early intervention and prevention of the suffering of symptomatic oesophageal adenocarcinoma and premature death.
OPENING ARGUMENT
The quandaries and uncertainties that occur in the minds of both the patient and their doctor when confronted with a diagnosis of BO illustrate the dilemmas of post modern evidence based medicine. Presentation of the facts leads to diverse interpretations. Surveillance can reveal ubiquitous human folly, best exposed by Swift’s wretched Struldbrugs decaying into immortality (Gullivier’s Travels, 1726). I will argue that Barrett’s surveillance prolongs life not death, relieving suffering. The current myopic approach to patients with BO exposes the “shoulder shrug” of restrictive reactive medicine.
THE WEIGHT OF EVIDENCE
Is the disease an “important” health problem?
To justify screening, the disease must meet …