Minute adenocarcinoma on Barrett's esophagus: the importance of directed biopsy sampling.

Patients with Barrett's esophagus (BE) have a risk of esophageal cancer thirty times higher than the general population. The grade of dysplasia must be established during endoscopic follow-up. The effectiveness of endoscopic surveillance programs for the diagnosis of advanced esophageal adenocarcinoma has been questioned. Several techniques are available for the early identification of high-grade dysplasia and biopsy sampling in all four quadrants every 2 cm is the most common procedure. However, accurate protocol compliance is challenging for some conditions, including long BE, due to the excessive number of biopsies that may be required.