{"entity":{"id":"idea-prev-barrett-surveillance-deescalation","kind":"idea","name":"Stop routine endoscopies for non-dysplastic Barrett's oesophagus","aka":[],"tldr":"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.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["esophageal"],"sections":["early-detection"],"technologies":[],"targets":["tp53"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"Implement and monitor via registry; embedded RCT of biomarker-stratified surveillance.","maturity":"early-clinical","actor":"policy","cost":"small","horizonYears":4},"route":"/ideas/idea-prev-barrett-surveillance-deescalation/","neighbours":{"cancer":[{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"target":[{"id":"tp53","kind":"target","name":"TP53","route":"/targets/tp53/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}