ideasIdea
Stop routine endoscopies for non-dysplastic Barrett's oesophagus
People with Barrett's oesophagus without dysplasia have endoscopies every few years, but the BOSS trial found no survival benefit. Redirecting effort to those with dysplasia would save harm and cost.
BOSS (UK) randomised surveillance versus at-need endoscopy and found no mortality benefit. Propose guideline change to stop routine surveillance for non-dysplastic short-segment Barrett's, replacing it with capsule sponge or biomarker (p53, TFF3) risk stratification to select the minority for surveillance.
Hypothesis
Biomarker-stratified surveillance reduces endoscopies by at least 60% with no increase in oesophageal adenocarcinoma mortality.
Rationale
Randomised evidence of no benefit; p53 immunohistochemistry identifies the progressors.
What would test it
Implement and monitor via registry; embedded RCT of biomarker-stratified surveillance.
Maturity
early clinical
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
4
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
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- TechnologyActive surveillance