• Dysplastic lesions are often flat and indistinguishable endoscopically |
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• Variations in diagnostic criteria for Barrett's oesophagus and dysplasia |
• Wide variations in local protocols (e.g. how often surveillance should be conducted if at all, the number of biopsies) |
• Imaging protocols do not achieve subcellular resolution and biopsies are still required |
• Submucosal deep abnormalities may not be detected even when the area is biopsied |
• Sampling bias (dysplasia may be focal, patchy or diffuse) |
• Surveillance is time consuming and costly |