title: Acetic acid compared with i-scan imaging for detecting Barrett's esophagus: a randomized, comparative trial.
abstract: BACKGROUND
  Traditional surveillance in patients with Barrett's esophagus (BE) has relied on random biopsies. Targeted biopsies that use advanced imaging modalities may significantly improve detection of specialized columnar epithelium (SCE).
  
  
  OBJECTIVE
  We compared the efficacy of targeted biopsies that used i-scan or acetic acid to random biopsies in the detection of SCE.
  
  
  METHODS
  Patients with visible columnar lined epithelium or known BE were randomized at a 1:1 ratio to undergo acetic acid application or i-scan with targeted biopsies.
  
  
  METHODS
  Targeted biopsies were performed based on surface architecture according to the Guelrud classification followed by 4-quadrant biopsies.
  
  
  METHODS
  A total of 95 patients were randomized.
  
  
  METHODS
  A total of 46 patients underwent acetic acid staining, and 49 underwent i-scan imaging. Random biopsies were performed in 86 patients.
  
  
  METHODS
  The primary outcome was the yield of SCE as confirmed by histologic assessment.
  
  
  RESULTS
  The diagnostic yield for SCE was significantly higher with targeted biopsies than with random biopsies in both groups combined (63% vs 24%; P = .0001). The yield of targeted biopsies was significantly greater with both i-scan (66% vs 21%; P = .009) and acetic acid (57% vs 26%; P = .012) technologies and did not differ between these groups. The accuracy for predicting SCE was 96% (k = .92) for i-scan and 86% (k = .70) for acetic acid analysis.
  
  
  CONCLUSIONS
  No dysplastic lesions were found.
  
  
  CONCLUSIONS
  The i-scan or acetic acid-guided biopsies have a significantly higher diagnostic yield for identifying SCE, with significantly fewer biopsies, as compared with a protocol of random biopsies. Acetic acid and i-scan showed comparable results diagnosing SCE in our study. (
  
  
  BACKGROUND
  NCT01442506.).
authors: St. Mary's Hospital, Department of Internal Medicine, Gastroenterology, and Oncology, Frankfurt, Germany; Medical Department, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors: Arthur
authors: A
authors: Hoffman
authors: St. Mary's Hospital, Department of Internal Medicine, Gastroenterology, and Oncology, Frankfurt, Germany.
authors: Oliver
authors: O
authors: Korczynski
authors: Institute for Genetics, University of Cologne, Cologne, Germany.
authors: Achim
authors: A
authors: Tresch
authors: Institute of Pathology, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors: Torsten
authors: T
authors: Hansen
authors: Medical Department, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors: Farreed
authors: F
authors: Rahman
authors: Medical Department, Johannes Gutenberg University of Mainz, Mainz, Germany; Medical Department, University of Tübingen, Tübingen, Germany.
authors: Martin
authors: M
authors: Goetz
authors: Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
authors: Sanyaj
authors: S
authors: Murthy
authors: Medical Department, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors: Peter R
authors: PR
authors: Galle
authors: St. Mary's Hospital, Department of Internal Medicine, Gastroenterology, and Oncology, Frankfurt, Germany; Medical Department, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors: Ralf
authors: R
authors: Kiesslich
mesh_terms: D019342:Acetic Acid; D001471:Barrett Esophagus / Q000473:pathology*; D004396:Coloring Agents; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging
chemical_list: D004396:Coloring Agents; D007202:Indicators and Reagents; D019342:Acetic Acid
keywords: BE; Barrett’s esophagus; CLE; NBI; SCE; columnar-lined lower esophagus or columnar-lined epithelium; narrow-band imaging; specialized columnar epithelium