In this issue of Gastroenterology, Duits et al1 from the Netherlands have expanded on their prior contributions to the low-grade dysplasia (LGD) literature in a study that examined outcomes of patients screened but not eligible for the SURF (Surveillance vs Radiofrequency Ablation) randomized clinical trial of radiofrequency ablation versus surveillance for LGD as well as those in the observation only group of that study.1 They found that 45 of the 255 patients (18%) with baseline LGD developed high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) during a median of 42 months of follow-up if 3 expert pathologists agreed on the presence of LGD.