# Stop routine endoscopies for non-dysplastic Barrett's oesophagus

Source: https://onco.cc/ideas/idea-prev-barrett-surveillance-deescalation/  
OnCo record `idea-prev-barrett-surveillance-deescalation` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Implement and monitor via registry; embedded RCT of biomarker-stratified surveillance.
- Maturity: early-clinical
- Actor: policy

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- targets: [TP53](https://onco.cc/targets/tp53/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

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