Barrett's oesophagus: better left alone?

The risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus is overrated in most publications, including meta-analyses. The upper limit of the overall risk is currently estimated at 0.5 per 100 patients per year. This means that one cancer may occur out of 200 patients followed for one year. Furthermore, a large fraction of patients with Barrett's oesophagus have a precarious health status, either from advanced age or from a chronic severe disease. Management is based upon a careful index endoscopy; accordingly, patients positive for dysplasia must be strictly observed or treated. Endoscopic surveillance protocols aiming at early detection of neoplasia--and treatment--in patients without dysplasia are unjustified in most cases. On the other hand, a minority of male patients--providing a good performance status--should enter into surveillance protocols when high-risk factors such as a long history of reflux symptoms and smoking habits are present.