Barrett's oesophagus: size does matter

For several decades, the incidence of oesophageal adenocarcinoma (OAC) has shown the highest proportional rise among all cancers in the Western world. In order to detect neoplasia at a curable stage, endoscopic surveillance of patients with its precursor lesion Barrett's oesophagus (BO) is recommended by various societal guidelines and as such has been widely implemented over the past decades. However, although surveillance endoscopy is intuitively rational, there is currently no proof from randomised trials that this strategy reduces OAC mortality, and its cost-effectiveness has been questioned. The observation that <8% of OAC is preceded by a BO diagnosis further undermines the impact of surveillance. Recent population-based studies have shown a much lower overall cancer risk in BO than previously anticipated, and together with the growing emphasis on healthcare cost containment, the rationale for endoscopic surveillance has come under greater scrutiny.1 2 A 2014 cost-utility analysis...
Source: Gut - Category: Gastroenterology Authors: Tags: Commentary Source Type: research