New duodenoscope designs: not what we had hoped for

underwent surveillance for high-risk EAC.As we mention in the discussion, this was a preselected cohort, in which frail and elderly patients with a higher likelihood of dying of causes not related to EAC were more likely to have been offered endoscopic surveillance instead of surgery, especially in earlier years (treatment paradigms have undergone immense changes).Therefore, we do not think that this cohort is suitable for the wanted predictive analysis.To obtain valuable predictive information regarding EAC-unrelated death, one acquires information about a larger group of patients treated for high-risk EAC, including patients who have undergone surgery and patients who have not undergone treatment.In addition, owing to the retrospective nature of the study, it might be challenging to obtain such detailed information about comorbidity.Besides, it may be a disproportionate amount of work with limited relevance, given that the PREFER study (NCT03222635), a prospective international multicenter study including all patients with high-risk EAC undergoing endoscopic therapy and surveillance, is currently running; in that study we also log patients undergoing surgery or no treatment. 3 However, because our research group is very much interested in individualizing treatment, Verheij et al 4 analyzed data in our Dutch nationwide cohort regarding EAC-unrelated death after successful endoscopic treatment in low-risk EAC.They found that the risk of dying of causes other than EAC after successful endoscopic therapy is 40 times higher than the risk of dying of recurrent EAC, and that the beneficial effect of intensive follow-up care is likely overstated.Although we cannot directly compare our highrisk EAC population with the low-risk population, one might hypothesize that we could de-intensify the surveillance intervals in some high-risk patients, depending on their risk profile, also taking into account their risk to die of an EAC-unrelated cause.Hopefully, future studies will help us individualize treatment and surveillance options in all patients with EAC.