Ablative mucosectomy is the procedure of choice to prevent Barrett's cancer.

OPENING ARGUMENT Stark strategies face patient and clinician in the presence of a degenerating dysplastic Barrett’s mucosa. Surgical removal offers an overaggressive flawed approach reminiscent of the politics of “Total War” (Karl Von Clausewitz 1780–1831: “Vom Kriege”). Decisive action assures eradication but without definitive knowledge of the threat and incurring extensive collateral damage. Surveillance waits for the cancer to develop; then offers a belated radical solution. Selective mucosal ablation is an active directed therapy offering a targeted pre-emptive preventative strike. I propose that mucosal ablation is currently the procedure of choice to prevent Barrett’s cancer.