• BARRETT'S CARCINOMA
• BARRETT'S METAPLASIA
• BARRETT'S OESOPHAGUS
• DYSPLASIA
• ENDOSCOPIC PROCEDURES

Philip Hendy reviewing Small et al.1

This retrospective cohort study comparing radiofrequency ablation with surveillance in Barrett's oesophagus with confirmed low-grade dysplasia adds real clinical practice data to the recent randomised control data, and its results are in concordance with the recent change in British Gastroenterology Society guidelines.

Oesophageal adenocarcinoma (OAC) has a high mortality rate and an increasing incidence. Barrett's oesophagus (BO) is a recognised precursor of OAC. Dysplasia in Barrett's tissue is the most potent prognosticator of progression from BO to OAC. In BO with either high-grade dysplasia (HGD) or OAC confined to the mucosa, there is clear evidence that endoscopic eradication of the Barrett's mucosa reduces progression to OAC and is superior to both surveillance and surgical oesophagectomy. This practice is recommended in national society guidelines.2 It is less clear what the optimal strategy to manage BO with low-grade dysplasia (LGD) is. This lack of clarity is due to the conflicting data regarding progression rates of LGD to HGD and OAC. A low rate of progression would favour a surveillance strategy, while a high rate would favour an interventional strategy with effective endoscopic therapy such as radiofrequency ablation (RFA). Early publications reported low rates of progression from LGD to HGD and OAC (1.8–2.7%3), while more recent studies have suggested …