Revision needed of follow-up policy for Barrett's esophagus

The frequency of adenocarcinomas at the oesophagocardial junction is increasing and, if symptomatic, the patients chances of cure are bleak. Given the association of Barrett's oesophagus (Barrett's oesophagus; denoting metaplasia of the oesophageal squamous cell lining to gastric-type mucosa) and oesophageal adenocarcinoma, it is plausible that establishing the presence of Barrett's oesophagus will subsequently enable two preventive strategies: primary, i.e. the treatment and eradication of Barrett's oesophagus, and secondary, the early diagnosis of (pre)malignancy during periodic endoscopic follow-up. Given the frequent occurrence of Barrett's oesophagus and the rarity of oesophageal adenocarcinoma there is a clear risk of overdiagnosis and overtreatment. Most studies on the effect of regular follow-up are uncontrolled and barely give any indication of a favourable outcome. Only a minority of patients with Barrett's oesophagus ought to have periodic endoscopic checkups: those with dysplasia or with one or more of the known risk factors (especially male gender, specialised type Barrett's oesophagus and long segment Barrett's oesophagus). Those patients must be healthy enough beforehand to undergo surgical treatment if necessary. The amount of quantity or quality of life that may be gained from this approach has yet to be established.