LGD in BE is an overdiagnosed and yet underestimated entity in general practice. Patients diagnosed with LGD should undergo an expert pathology review to purify this group. In case the diagnosis of LGD is confirmed, patients should undergo strict endoscopic follow-up or should be considered for endoscopic ablation therapy.

ISRCTN46462267 ( http://www.controlled-trials.com).

Gastroesophageal variceal bleeding in patients with cirrhosis is associated with significant morbidity and mortality, as well as a high rebleeding risk. Limited data are available on the role of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents in patients receiving standard endoscopic, vasoactive, and antibiotic treatment. In this multicenter randomized trial, long-term endoscopic variceal ligation (EVL) or glue injection 1 b-blocker treatment was compared with TIPS placement in 72 patients with a first or second episode of gastric and/or esophageal variceal bleeding, after hemodynamic stabilization upon endoscopic, vasoactive, and antibiotic treatment. Randomization was stratified according to Child-Pugh score. Kaplan-Meier (event-free) survival estimates were used for the endpoints rebleeding, death, treatment failure, and hepatic encephalopathy. During a median follow-up of 23 months, 10 (29%) of 35 patients in the endoscopy 1 b-blocker group, as compared to 0 of 37 (0%) patients in the TIPS group, developed variceal rebleeding (P 5 0.001). Mortality (TIPS 32% vs. endoscopy 26%; P 5 0.418) and treatment failure (TIPS 38% vs. endoscopy 34%; P 5 0.685) did not differ between groups. Early hepatic encephalopathy (within 1 year) was significantly more frequent in the TIPS group (35% vs. 14%; P 5 0.035), but during longterm follow-up this difference diminished (38% vs. 23%; P 5 0.121). Conclusions: In unselected patients with cirrhosis, who underwent successful endoscopic hemostasis for variceal bleeding, covered TIPS was superior to EVL 1 b-blocker for reduction of variceal rebleeding, but did not improve survival. TIPS was associated with higher rates of early hepatic encephalopathy. (HEPATOLOGY 2016;63:581-589) G astroesophageal variceal bleeding (GEVB) is a severe complication of portal hypertension. Rebleeding is associated with significant morbidity and mortality. Hospitalization costs for rebleeding range between $6,600 and $23,000 in the United States.For these reasons, management should be directed at its prevention.1,2 Secondary prevention is first achieved by endoscopic treatment (endoscopic variceal ligation [EVL] for esophageal varices and N-butyl cyanoacrylate injection for gastric varices) in combination with bAbbreviations: CI, confidence interval; EVL, endoscopic variceal ligation; GEVB, gastroesophageal variceal bleeding; HCC, hepatocellular carcinoma; HR, hazard ratio; IQR, interquartile range; MELD, Model for End-Stage Liver Disease; PTFE, polytetrafluorethylene; TIPS, transjugular intrahepatic portosystemic shunt.From the Departments of

No abstract

Surveillance of Barrett's oesophagus allows us to study the evolutionary dynamics of a human neoplasm over time. Here we use multicolour fluorescence in situ hybridization on brush cytology specimens, from two time points with a median interval of 37 months in 195 non-dysplastic Barrett's patients, and a third time point in a subset of 90 patients at a median interval of 36 months, to study clonal evolution at single-cell resolution. Baseline genetic diversity predicts progression and remains in a stable dynamic equilibrium over time. Clonal expansions are rare, being detected once every 36.8 patient years, and growing at an average rate of 1.58 cm2 (95% CI: 0.09–4.06) per year, often involving the p16 locus. This suggests a lack of strong clonal selection in Barrett's and that the malignant potential of ‘benign' Barrett's lesions is predetermined, with important implications for surveillance programs.