The BOSS trial with more than 12 years of follow-up showed no improvement in overall or cancer-specific survival with scheduled 2-year surveillance endoscopy compared with at-need endoscopy in patients with Barrett’s esophagus.

Rates of esophageal adenocarcinoma, cancer-related mortality, and stage at diagnosis were similar between both strategies.

Surveillance patients underwent far more procedures (over 6,000 versus 2,400), but this did not translate into survival benefit.

The findings suggest that routine 2-year surveillance may not be necessary for low-risk, nondysplastic Barrett’s esophagus.

An at-need approach could ease the burden on endoscopy resources without compromising patient outcomes.

Current guidelines recommending surveillance every 3 to 5 years may still be too aggressive for some patients.

Risk stratification will be important to determine which patients may benefit from longer surveillance intervals versus closer monitoring.

Source: Gastroenterology