Nine in ten Barrett cancers arrived without any prior endoscopy

The edition in brief

A Dutch nationwide study identified 8,914 patients treated curatively for Barrett-related dysplasia or oesophageal adenocarcinoma between 2008 and 2018. Ninety per cent (95% CI 89-91) had no prior endoscopy showing non-dysplastic Barrett oesophagus in the preceding one to five years. Sixty-five per cent had stage II disease or worse, concentrated in that group: 70% of those presenting de novo against 11% of those under surveillance. Among the 1,989 treated endoscopically, 65% still presented de novo. Surveillance worked well for those inside it - only 11% of those with prior endoscopy had missed advanced neoplasia - but most patients were never in it. The US Multi-Society Task Force has issued a consensus statement on serrated polyposis syndrome, the commonest polyposis syndrome and one that often goes unrecognised. Diagnosis rests on WHO clinical criteria covering the size, cumulative number and location of serrated polyps. Management is meticulous inspection, complete clearing of the colon and frequent surveillance, with surgery for cancer or for a polyp burden an expert endoscopist cannot control. There is no common germline variant, so genetic testing is indicated only where a known hereditary syndrome is suspected on other grounds, and first-degree relatives need colonoscopic screening. Among 679 outpatients with cirrhosis across seven countries, 25% were admitted within 90 days. Adding stool metagenomic features to a clinical model raised discrimination from an area under the curve of 0.79 to 0.84. A Rome V survey of caregivers of 8,000 children found disorders of gut-brain interaction in 28.0%.