• oesophagus
• carcinoma
• high grade dysplasia
• interobserver agreement

The rapidly rising incidence of oesophageal adenocarcinoma in the Western world has stimulated considerable experimental and clinical research in recent years. After a long period of uncertainty, it is now generally held that the majority, if not all, of these cancers arise on a background of intestinal metaplasia (Barrett’s oesophagus), secondary to chronic gastro-oesophageal reflux. While there has been much debate on the risk of cancer development, it is again accepted that in a proportion of patients, this metaplastic epithelium becomes unstable, leading to a sequential progression through dysplasia to carcinoma. Considerable effort has gone into characterising the changes which seem to occur at the molecular level ¹.

In this issue, Ormsby and colleagues² suggest that it may be important to distinguish high grade dysplasia (HGD) from intramucosal carcinoma (IMC) in order to reach a decision about endoscopic surveillance and how this might influence the nature and timing of subsequent therapy [see page 671]. They show that the distinction between HGD and IMC is not easily …