How Often Is Surveillance Endoscopy Required?
The data regarding appropriate intervals for surveillance endoscopy are limited. Cancer develops in only about 7% of patients with low-grade dysplasia, and some studies have found no difference in the development of cancer among patients with low-grade dysplasia and those with no dysplasia. Thus, in patients with no dysplasia on two consecutive endoscopies with systematic biopsies, current guidelines recommend a 3-year follow-up interval. If low-grade dysplasia is found, the endoscopy should be repeated to confirm that this is the highest grade of dysplasia in the esophagus. Subsequently an annual endoscopy is sufficient until no dysplasia is found on two consecutive endoscopies (Table 1). The risk of cancer is higher in patients with high-grade dysplasia and guidelines for these patients are more controversial. Determining the time course of progression from one level of dysplasia to the next is difficult. Low-grade dysplasia can progress to cancer over a 4-year interval, and in patie
