Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video).
BACKGROUND
Currently, various advanced endoscopic techniques are available with varying success rates. These technologies are manufacturer dependent, which has financial implications in the current era of austerity. Acetic acid is a commonly available dye that has been used in the detection of neoplasia within Barrett's esophagus. It has been shown to be effective in detecting neoplasia in high-risk subgroups, but its efficacy in a low-prevalence surveillance population remains unproven.


OBJECTIVE
This study aimed to investigate the effectiveness of acetic acid chromoendoscopy in a Barrett's esophagus surveillance population. We aimed to compare the neoplasia yield of acetic acid chromoendoscopy (AAC) with the neoplasia yield from standardized random biopsy (SBP) protocol-guided biopsies in the routine surveillance of patients with Barrett's esophagus.


METHODS
Retrospective cohort study.


METHODS
Tertiary referral hospital in the United Kingdom.


METHODS
Patients 18 years of age and older with a diagnosis of Barrett's esophagus undergoing surveillance gastroscopy.


METHODS
AAC versus standardized random biopsy protocol (SBP) for Barrett's esophagus surveillance.


METHODS
Neoplasia detection in 2 groups.


RESULTS
The overall neoplasia detection rates for all grades of neoplasia were 13 of 655 (2%) in the SBP-guided biopsy cohort and 41 of 327 (12.5%) in the AAC cohort (P = .0001). On per-patient analysis, a 6.5-fold gain in neoplasia detection was seen in the AAC cohort compared with the SBP cohort (0.13 vs 0.02, P = .000). In the SBP cohort, a total of 13 of 655 (2%) neoplasias were detected, of which 3 of 655 patients (0.5%) had low-grade dysplasia, 7 of 655 (1%) had high-grade dysplasia, and 3 of 655 (0.5%) were found to have superficial cancer (T1a/T1b). In the AAC cohort, a total of 41 of 327 neoplasias (12.5%) were found, of which 9 of 327 patients (2.7%) had low-grade dysplasia, 18 of 327 (5.5%) had high-grade dysplasia, and 14 of 327 (4.2%) were found to have superficial cancer. The number of biopsies required to detect 1 neoplasia was 15 times lower in the AAC cohort (40 biopsies) than in the SBP cohort (604 biopsies). On per-biopsy analysis, a 14.7-fold increase in neoplasia detection was seen in the AAC cohort per biopsy compared with the SBP cohort (0.025 vs 0.0017; P = .000).


CONCLUSIONS
Not a randomized, controlled study.


CONCLUSIONS
Our study demonstrates that acetic acid detects more neoplasias than conventional protocol-guided mapping biopsies and requires 15 times fewer biopsies per neoplasia detected.
Queen Alexandra Hospital, Portsmouth, United Kingdom.
Shareef
S
Tholoor
Queen Alexandra Hospital, Portsmouth, United Kingdom.
Rupam
R
Bhattacharyya
Queen Alexandra Hospital, Portsmouth, United Kingdom.
Orestis
O
Tsagkournis
Queen Alexandra Hospital, Portsmouth, United Kingdom.
Gaius
G
Longcroft-Wheaton
Queen Alexandra Hospital, Portsmouth, United Kingdom.
Pradeep
P
Bhandari
D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D007202:Indicators and Reagents; D019342:Acetic Acid