In the largest randomized controlled trial of its kind (BOSS Trial, Gastroenterology, 2025), over 3,400 UK patients with non-dysplastic or low-grade dysplastic Barrett’s esophagus were followed for a median of 12.8 years. The study compared scheduled endoscopic surveillance every 2 years versus endoscopy only when symptoms emerged.
🔍 Key Findings:
- No significant difference in overall survival (19.2% vs. 20.7%; HR 0.95, P=0.52)
- No difference in esophageal cancer mortality or stage at diagnosis
- High rates of crossover in the at-need group (59% had endoscopy)
- Study likely underpowered given today’s lower annual progression rates of BE to EAC
📌 Clinical Insight from Dr. Zhou:
While the trial was a critical step in evidence generation, its interpretation demands caution. The similar endoscopy frequency across groups, lack of IM in 25% of patients, and limited power to detect cancer-specific mortality differences all cloud definitive conclusions. U.S. clinicians should consider