LAUSR

ded by all leading gastroenterology societies worldwide [1, 2]. The rationale for such a strategy is supported by several retrospective studies that have demonstrated reduced esophageal adenocarcinoma (EAC)-related mortality and earlier stage diagnosis of cancer in patients receiving endoscopic monitoring as compared with patients not undergoing surveillance [3]. How should the endoscopic monitoring be performed? Despite the overwhelming technological progress that has been made in the field of endoscopy, to date, the gold standard of BE surveillance relies on a biopsy protocol that was established nearly three decades ago – in the era of fiberoptics! The Seattle protocol involves targeted forceps biopsies (FBs) for any visible lesion, followed by a set of biopsies every 1–2 cm in four quadrants of the BE segment. Unfortunately, this protocol is deemed labor-intensive and time-consuming, resulting in poor compliance among clinicians, especially for long-segment BE and in nonexpert centers [4]. Moreover, only an estimated 4%–6% of the BE area is sampled with this technique, which may lead to the inevitable risk of missing focal dysplasia [5]. This caveat also underlies the rate of missed EAC within surveillance cohorts, which can be as high as 14% [6].