COMMENTARY

Risk for Progression to Cancer in Barrett's Esophagus

David A. Johnson, MD

Disclosures

November 04, 2011

In This Article

The Value of Screening Patients With BE

These recent studies all raise significant questions about the value of screening and surveillance of BE that is currently justified in clinical practice. Clearly, the rationale for the current screening and surveillance recommendations can be questioned and needs re-evaluation. The overall low rate of progression of nondysplastic BE to HGD or cancer reinforces the current expert consensus that routine endoscopic ablation of nondysplastic BE is not justifiable. Furthermore, current data demonstrate a normal life expectancy for patients with BE in whom EAC is an uncommon cause of death regardless of surveillance practice. Although BE is clearly associated with increased risk for EAC, the question is: If we are providing a service that is not cost-effective and does not reduce mortality, should this be our practice? Further epidemiologic data from large cohort populations are forthcoming and will further substantiate the much lower risk for EAC and lack of associated mortality for patients with BE.

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