An esophageal biopsy that cannot be definitively classified as dysplastic or non-dysplastic in a patient with Barrett's esophagus defines a specific clinical situation — one that requires a distinct, guideline-supported management approach.
This protocol applies when an esophageal biopsy in a Barrett's esophagus patient is reported as indefinite for dysplasia (IND) and this finding has been confirmed by an expert gastrointestinal pathologist. This diagnosis arises when the pathologist cannot determine whether the histology truly represents dysplasia or may instead reflect inflammatory changes. International guidelines are unanimous: IND must be confirmed by an expert GI pathologist before any further management steps are initiated.
Once the IND diagnosis is confirmed, the protocol centres on intensification of antireflux therapy. The specific therapeutic adjustment, the monitoring timeline, and the follow-up endoscopy plan are set out in the full structured regimen.
This diagnosis is made when the pathologist is unable to determine whether the histology truly represents dysplasia or may be due to inflammatory changes.
There is uniform agreement across international guidelines that a diagnosis of IND should first be confirmed by an expert GI pathologist.
For confirmed cases, antireflux therapy should be intensified, followed by a repeat endoscopy within 6 months.
DOI: 10.14309/ajg.0000000000001680
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