When Barrett's esophagus histology is neither clearly dysplastic nor clearly non-dysplastic, the diagnosis is classified as indefinite for dysplasia (IND). This specific category requires a defined clinical pathway distinct from confirmed low-grade or high-grade dysplasia.
IND is not uncommon — it is found in up to 8.4% of patients with Barrett's esophagus. Accurate diagnosis depends on expert pathology review, and the evaluation pathway reflects both the need to confirm the IND designation and to exclude higher-grade pathology.
The approach for confirmed IND centres on proton pump inhibitor therapy combined with targeted endoscopic management of any visible lesions. A specific endoscopic eradication strategy applies to this diagnosis.
The full protocol — covering the re-evaluation timeline, biopsy sampling approach, and the precise role of eradication therapy in this setting — is available in the complete regimen.