Oesophageal pathology following ablation of Barrett's mucosa

Barrett's oesophagus (BO) is a major risk factor for the development of oesophageal adenocarcinoma. Oesophageal adenocarcinoma is preceded by pre-malignant epithelial changes, i.e. low-grade dysplasia and high-grade dysplasia. Endosocopic surveillance programmes have been implemented to monitor these pre-malignant changes. In the last decade, much effort has been invested in non-invasive, low-risk, ablative techniques for elimination of BO as an alternative for oesophagectomy, which confers substantial morbidity and mortality. The rationale for ablative elimination of BO is to reduce or abolish the risk of malignant progression. However, at present, there is no convincing evidence that this risk is truly diminished. Residual or recurrent glands are commonly found after ablation and can be detected next to or underneath (neo)squamous epithelium. Moreover, molecular abnormalities associated with malignant progression have been detected in these glands. This review addresses histopathological aspects of oesophageal biopsy specimens after ablation of BO.