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Introduction Assessment of dysplasia in Barrett’s oesophagus is subject to significant interobserver variability, which will directly impact future patient management. This study aimed to evaluate histological outcomes on follow-up in patients whose highest recorded histological diagnosis was indefinite for dysplasia (IND).Methods A retrospective review of all oesophageal biopsies reported as Barrett’s oesophagus between 2021 and 2023 was performed using the Beaker Epic database. Cases from Addenbrooke’s Hospital and King’s Lynn Hospital with the highest diagnosis of IND were identified. Subsequent histological follow-up biopsies were reviewed. p53 immunohistochemistry results were recorded where available. Outcomes were categorised as negative for dysplasia, persistent IND, dysplasia (low or high grade), or intramucosal carcinoma.Results Across the three-year period, IND accounted for 3.4% of Barrett’s oesophagus biopsies. Follow-up data were available for 77 of 90 cases (86%). On follow-up, 57% of cases were negative for dysplasia, 7.4% remained indefinite, 17% progressed to low- or high-grade dysplasia, and 4.6% progressed to intramucosal carcinoma. p53 immunohistochemistry demonstrated predominantly wild-type expression in 85% of IND cases. Among cases that progressed to dysplasia or carcinoma, 75% showed wild-type p53 staining, and aberrant expression was identified in 25%.Conclusions Most Barrett’s oesophagus cases initially diagnosed as IND were negative for dysplasia on follow-up, consistent with inflammatory or reactive atypia; however, a clinically significant minority progressed to dysplasia or intramucosal carcinoma, supporting early endoscopic reassessment following medical optimisation with high dose proton pump inhibitor. p53 immunohistochemistry showed limited sensitivity for predicting progression and should be interpreted as an adjunct to morphology and clinical context.