Editor,—We were interested to read the case report by Van Laethem and colleagues of a carcinoma arising under a re-epithelialised segment of Barrett's oesophagus ((2000) Gut 46:574–577; OpenUrlCrossRefPubMedWeb of Science). This raises issues in the debate over ablation of Barrett's epithelium. There has been interest in ablating the columnar epithelium to encourage squamous regrowth which may reduce the risk of progression to adenocarcinoma. However, there have been numerous reports of buried glands under the regenerated mucosa.1-3

While we accept that columnar glands may persist under the squamous epithelium and that this may represent a continuing carcinoma risk, this is difficult to quantify. Indeed, this is the first report of such a malignant change. It may be that as any buried glands are no longer exposed to potential carcinogens in the form of acid or bile reflux, the risk is reduced. Although the ultimate aim of treatment is to eliminate the risk of potential malignant change, any means of reducing such risk, for example by diminution of the volume of metaplastic tissue, would be worthwhile. This whole issue needs further evaluation by appropriately designed clinical trials.4