title: Acetic acid spray is an effective tool for the endoscopic detection of neoplasia in patients with Barrett's esophagus.
abstract: OBJECTIVE
  Diagnosis of Barrett's neoplasia requires collection of large numbers of random biopsy samples; the process is time consuming and can miss early-stage cancers. We evaluated the role of acetic acid chromoendoscopy in identifying Barrett's neoplasia.
  
  
  METHODS
  Data were collected from patients with Barrett's esophagus examined at a tertiary referral center, between July 2005 and November 2008 using Fujinon gastroscopes and EPX 4400 processor (n = 190). All procedures were performed by a single experienced endoscopist. Patients were examined with white light gastroscopy and visible abnormalities were identified. Acetic acid (2.5%) dye spray was used to identify potentially neoplastic areas and biopsy samples were collected from these, followed by quadrantic biopsies at 2 cm intervals of the remaining Barrett's mucosa. The chromoendoscopic diagnosis was compared with the ultimate histological diagnosis to evaluate the sensitivity of acetic acid chromoendoscopy.
  
  
  RESULTS
  Acetic acid chromoendoscopy had a sensitivity of 95.5% and specificity of 80% for the detection of neoplasia. There was a correlation between lesions predicted to be neoplasias by acetic acid and those diagnosed by histological analysis (r = 0.98). There was a significant improvement in the detection of neoplasia using acetic acid compared with white light endoscopy (P = .001).
  
  
  CONCLUSIONS
  Analysis of this large series showed that acetic acid-assisted evaluation of Barrett's esophagus detects neoplasia better than white light endoscopy, with sensitivity and specificity equal to that of histological analysis.
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Gaius
authors.initials: G
authors.lastname: Longcroft-Wheaton
authors.forename: Moses
authors.initials: M
authors.lastname: Duku
authors.forename: Robert
authors.initials: R
authors.lastname: Mead
authors.forename: David
authors.initials: D
authors.lastname: Poller
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000175:diagnosis*; D001706:Biopsy / Q000379:methods; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D019342:Acetic Acid