Surveillance of Barrett's esophagus

Surveillance in the context of Barrett's esophagus (BE) implies follow-up endoscopy and biopsy of a patient with established BE. Therefore, we must have a clinical definition of BE, have criteria for which patients with BE should be surveyed, define the intervals of surveillance, and prescribe the biopsy protocol. There are no randomized trials of surveillance in BE, so evidence-based experts say not to survey. Whatever the documented value of surveillance, we need to identify the issues in the clinical context. The availability of effective, cost-effective, and safe ablation techniques for Barrett's neoplasia (dysplasia and early adenocarcinoma) provides an impetus to identify these neoplastic lesions to apply treatments to reduce the progression to cancer. The identification of treatable neoplasia provides the pragmatic rational for surveillance. (C) 2010 Published by Elsevier Inc.