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Barrett's oesophagus surveillance biopsies represent a significant share of the daily workload for a busy histopathology department. Given the emphasis on endoscopic detection and dysplasia grading, it is easy to forget that the benefits of these screening programs remain unproven. The majority of patients are at low risk of progression to oesophageal adenocarcinoma, and periodic surveillance of these patients is burdensome and costly. Here, we investigate the parallels in the development of Barrett's oesophagus and other scenarios of wound healing in the intestine. There is now increased recognition of the full range of glandular phenotypes that can be found in patients' surveillance biopsies, and emerging evidence suggests parallel pathways to oesophageal adenocarcinoma. Greater understanding of the conditions that favour progression to cancer in the distal oesophagus will allow us to focus resources on patients at increased risk.

Original publication

DOI

10.1007/s00428-018-2317-1

Type

Journal article

Journal

Virchows Archiv : an international journal of pathology

Publication Date

01/2018

Volume

472

Pages

43 - 54

Addresses

Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Keywords

Humans, Adenocarcinoma, Esophageal Neoplasms, Barrett Esophagus, Disease Progression, Risk Factors, Early Detection of Cancer