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The absolute annual risk of patients with Barrett's oesophagus (BO) developing oesophageal adenocarcinoma (OAC) is ≤ 0.5%. Screening BO patients for malignant progression using endoscopic surveillance is widely practised. To assess the efficacy and cost-effectiveness of this, we developed a protocol for a randomized controlled trial of surveillance versus 'at need' endoscopy.In a multicentre trial, 3400 BO patients randomized to either 2-yearly endoscopic surveillance or 'at need' endoscopy will be followed up for 10 years. Urgent endoscopy will be offered to all patients who develop symptoms of dysphagia, unexplained weight loss > 7lb (3.2 kg), iron deficiency anaemia, recurrent vomiting, or worsening upper gastrointestinal symptoms. Participants must have endoscopically and histologically confirmed BO, with circumferential BO ≥ 1 cm or maximal tongue/island length ≥ 2 cm. Candidates with existing oesophageal high-grade dysplasia or cancer, or previous upper gastrointestinal cancer will be excluded. Primary outcome will be overall survival. Secondary outcomes will be cost effectiveness (cost per life year saved and quality adjusted life years); cancer-specific survival; time to OAC diagnosis and stage at diagnosis; morbidity and mortality related to any interventions; and frequency of endoscopy.This randomized trial will provide data to evaluate the efficacy and cost-effectiveness of screening BO patients for OAC.

Original publication




Journal article


Journal of medical screening

Publication Date





158 - 164


Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN.


BOSS Trial Team, Humans, Adenocarcinoma, Esophageal Neoplasms, Barrett Esophagus, Disease Progression, Endoscopy, Treatment Outcome, Risk, Follow-Up Studies, Research Design, Adult, Aged, Middle Aged, Cost-Benefit Analysis, Female, Male, Early Detection of Cancer, Young Adult