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To the Editor: I am surprised that the Clinical Crossroads Update by Dr Burns¹ did not comment on the statement that surveillance upper endoscopy for Barrett esophagus has been performed "every year as that is the patient's preference."¹ Mrs W had undergone 4 annual endoscopic examinations for Barrett esophagus without detecting dysplasia. Such a practice is inconsistent with current specialty society guidelines.^2-3 Endoscopy performed every 3 years would have been appropriate.

Physicians may order tests or prescribe medications that patients request but that are not appropriate. However, a physician's responsibility is to advise the patient about what constitutes sound contemporary evidence-based principles. Medical professionalism should direct clinicians not to perform procedures that are not indicated.

Financial Disclosures: None reported.

Todd LarRieu Sack, MD
tsack@bgclinic.com
Borland-Groover Clinic
Jacksonville, Fla

1. Burns RB. A 59-year-old woman with gastroesophageal reflux disease and Barrett esophagus, 4 years later. JAMA. 2006;296:2140. FREE FULL TEXT 2. Hirota WK, Zuckerman MJ, Adler DG, et al, Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006;63:570-580. FULL TEXT | ISI | PUBMED 3. The Society for Surgery of the Alimentary Tract Patient Care Committee. Practice guidelines for patients with gastrointestinal surgical diseases. J Gastrointest Surg. 1998;2:483-484. FULL TEXT | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297:699.

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