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Letter
Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett's oesophagus with low-grade dysplasia
  1. Massimiliano di Pietro,
  2. Rebecca C Fitzgerald
  3. on behalf of the BSG Barrett's guidelines working group
  1. MRC Cancer Unit, University of Cambridge,  Cambridge, UK
  1. Correspondence to Dr Massimiliano di Pietro, MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, P.O. Box 197, Cambridge CB2 0XZ, UK; md460{at}mrc-cu.cam.ac.uk

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The most recent guidelines for the management of Barrett's oesophagus published in 2014 recommended endoscopic surveillance for patient with histological evidence of low-grade dysplasia (LGD) on random biopsies.1 In the last 2 years, new evidence on the natural history of LGD in Barrett's oesophagus and on the safety and efficacy of endoscopic treatment in this subgroup of patients has been published.

Duits et al have conducted a retrospective analysis of 293 patients with LGD diagnosed in community hospitals.2 Following consensus review, the original LGD diagnosis was confirmed in 27% of cases, while the remaining of the cases were downgraded to non-dysplastic Barrett's oesophagus or indefinite for dysplasia (IND). Patients with a LGD consensus diagnosis had a progression rate to high-grade dysplasia (HGD) or cancer of 9.1%/year over a median follow-up of 39 months. By contrast, patients whose diagnosis was down-staged to either non-dysplastic Barrett's oesophagus or IND had a conversion rate of 0.6% and 0.9%/year, respectively (evidence grade: low). This study reiterates the difficulty in …

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