Case 1
—Woman aged 64. Endoscopy for dysphagia showed a stricture in a 100 mm length of Barrett’s mucosa with intestinal metaplasia. Biopsy samples from the stricture were benign. She was entered into the surveillance programme but four months later required additional endoscopies to investigate progressive dysphagia. She had multiple endoscopies over the next year because of a high suspicion of malignancy, but an adenocarcinoma was confirmed only at postmortem examination.Case
2—Woman aged 64. Endoscopy for dysphagia showed a stricture in an 110 mm length of Barrett’s mucosa with no evidence of dysplasia. Biopsy samples from the stricture were benign. She was entered into the surveillance programme, but increasing dysphagia prompted four additional endoscopies over the next year. The last of these identified squamous carcinoma. She was treated surgically and was alive six years later.Case 3
—Man aged 63. Endoscopy for dysphagia showed a stricture in a 100 mm length of Barrett’s mucosa with no evidence of dysplasia. Biopsy samples from the stricture were benign. An endoscopy 10 years previously had shown long segment non-dysplastic Barrett’s mucosa. He was entered into the surveillance programme and the next two annual reviews showed no change with no dysplasia. On the third annual review an asymptomatic adenocarcinoma was identified. He died one month after surgery to remove the carcinoma.Case 4—
Woman aged 63. Endoscopy for the investigation of anaemia revealed an 80 mm length of Barrett’s mucosa with intestinal metaplasia. She was examined annually for four years with no progression of her length of Barrett’s mucosa or evidence of dysplasia. She defaulted from follow up in 1995 but presented in 1997 with melaena and anaemia. Investigation showed an adenocarcinoma in the segment of Barrett’s mucosa. She had oesophagectomy to remove the T1 NO tumour and was alive and well three years later.Case
5—Man aged 50. Diagnostic endoscopy for haematemesis showed a 100 mm length of Barrett’s mucosa with intestinal metaplasia in 1990. Surveillance endoscopy in 1991 and 1992 showed no progression of Barrett’s mucosa or evidence of dysplasia. He defaulted from follow up but presented with dysphagia in 1996. Endoscopy and biopsy confirmed an adenocarcinoma within the Barrett’s mucosa . He died of recurrent disease.