Prevalent low-grade dysplasia: the strongest predictor of malignant progression in Barrett's columnar-lined oesophagus

Dear Professor Emad El-Omar, We read with interest the work by Duits et al 1 who find that validated low-grade dysplasia (LGD) is highly predictive of malignant progression in Barrett's oesophagus (BO). Yachimski2 stresses the need for this important finding to be validated in other centres. Our experience of prevalent LGD as a predictor of malignant progression in BO in the West of Scotland strongly reinforces the conclusions of our colleagues in the Netherlands. Patients with BO diagnosed between 1994 and 2009 at one centre (Glasgow Royal Infirmary (GRI)) all had BO visible endoscopically, with biopsy-proven metaplastic glandular mucosa in the tubular oesophagus. Exclusions for residence outside GRI catchment area, severe comorbidities, refusal of surveillance, loss to follow-up, high-grade dysplasia (HGD) or oesophageal adenocarcinoma (OA) at diagnosis (or ascertained within 1 year of index endoscopy), or being indefinite for dysplasia (n=15) left 145 short (≤3 cm) and 577 long (>3 cm) patients with BO in surveillance. Biopsy protocol was by endoscopist's choice. Endoscopy was biennial without LGD, and 3–6 monthly after LGD ascertainment. Patients with new HGD or OA were offered …