The working party of the BSG has recently produced a document updating recommended guidelines for the management of Barrett’s oesophagus (BO).¹ In this article, the main changes in recommendations are highlighted and their value in the context of the numerous other guidelines and manuscripts that are already available are discussed.

The two key “new” recommendations are

1. BO is defined as an endoscopically apparent area above the oesophagogastric junction that is suggestive of Barrett’s which is supported by the finding of columnar lined oesophagus on histology. The presence of areas of intestinal metaplasia (IM), although often present, is not a requirement for diagnosis.

2. For patients with BO but without dysplasia, the recommended surveillance protocols are two yearly, four quadrant biopsies every 2 cm, but jumbo biopsies are not required.

Additional recommendations include the advice that endoscopic screening of patients suffering from heartburn in order to detect BO is not recommended and that, in patients with non-dysplastic BO, ablation should be performed only in the context of prospective randomised studies.

The new recommended definition of what constitutes BO requires a combination of macroscopic and microscopic identification. In the latest definition, in order to have Barrett’s mucosa you have to be able to see it with an endoscope. This therefore excludes “ultra-short Barrett’s” and also does not …