Original articleClinical endoscopyAcetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video)
Section snippets
Objective
This study aimed to investigate the effectiveness of acetic acid chromoendoscopy (AAC) in a Barrett's esophagus surveillance population. We aimed to compare the neoplasia yield of AAC with the neoplasia yield from the standardized random biopsy protocol (SBP) in the routine surveillance of patients with Barrett's esophagus.
Techniques
This was a retrospective cohort study evaluating the differences in the outcomes of 2 different strategies of Barrett's esophagus surveillance: the standardized random biopsy protocol (SBP) and AAC protocol. All patients in the study provided informed signed consent for the procedure. The study was done as a service evaluation of Barrett's esophagus surveillance that our department provides and was approved by our institution (PHT 2639).
Patients were matched for age, Barrett's esophagus length,
Patient demographics
A total of 972 procedures were performed on 627 patients for Barrett's esophagus surveillance between October 2008 and June 2012. The median age of the patients was 66 years (range 22–87 years). Of the patients, 75% were male. The mean length of Barrett's esophagus was 4.4 cm (range 2–21 cm). The median Barrett's esophagus length was 5 cm with an interquartile range of 3 to 8 cm.
SBP cohort
This cohort included 655 of 972 (67%) patients who underwent SBP-guided biopsies. The median age was 66 years (range
Discussion
This is the largest and only series comparing the neoplasia detection rates between AAC- and SBP-guided biopsies in patients undergoing Barrett's esophagus surveillance endoscopy. We demonstrated that AAC significantly increases neoplasia detection rates compared with mapping biopsies by the SBP. The gain in neoplasia detection is seen on both per-patient and per-biopsy analysis. These results are very significant. Two large cohort studies demonstrated the efficacy of acetic acid for the
Conclusions
This is the first study to specifically examine the use of AAC in a surveillance population. It demonstrates that acetic acid detects more neoplasias than conventional protocol-guided mapping biopsies and requires 15 times fewer biopsies to detect neoplasia. We believe that this provides a compelling argument for further evaluation with a randomized, controlled trial.
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 503.