Clinical Pearl

You are screening your cirrhotic patient for varices with an EGD and you detect a long segment of salmon-colored esophageal mucosa.  Instinct tells you to biopsy it and document Barrett’s esophagus.  Careful.  Is there an esophageal varix beneath that tongue ready to bleed upon biopsy?  Maybe you should leave it alone, and here’s your rationale:

http://www.nejm.org/doi/full/10.1056/NEJMoa1103042

This NEJM article suggests that the actual rate of adenocarcinoma is much lower than you’d think.  And if the patient already has cirrhosis and portal hypertension, how many years of life is expected anyway…