Surveillance in Barrett's oesophagus

Barrett's oesophagus is a premalignant condition with an increasing incidence of adenocarcinoma. There remains uncertainty based on the lack of accurate information, not least the necessity for, effectiveness of, and optimal interval for surveillance of known cases. The incidence of oesophageal cancer may not be as high as previously supposed, which could influence both surveillance intervals and cost effectiveness. Issues around patient selection have not been satisfactorily resolved; although most patients at risk are elderly and die of other causes, advanced oesophageal cancer is an unpleasant condition and the prevention of the morbidity associated with this by endoscopic therapy of early lesions may be a worthwhile goal. Many patients drop out of surveillance programmes; some of the reasons appear to centre on the lack of information and point to the need to educate our patients if we believe surveillance to be worthwhile.