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.

DESIGN:

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.

SETTING:

Targeted biopsies were performed based on surface architecture according to the Guelrud classification followed by 4-quadrant biopsies.

PATIENTS:

A total of 95 patients were randomized.

INTERVENTION:

A total of 46 patients underwent acetic acid staining, and 49 underwent i-scan imaging. Random biopsies were performed in 86 patients.

MAIN OUTCOME MEASUREMENTS:

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.

LIMITATIONS:

No dysplastic lesions were found.

CONCLUSION:

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.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01442506.).

• Authors: Arthur Hoffman, Oliver Korczynski, Achim Tresch, Torsten Hansen, Farreed Rahman, Martin Goetz, Sanyaj Murthy, Peter R Galle, Ralf Kiesslich
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 79 Issue 1 Pg. 46-54 (Jan 2014) ISSN: 1097-6779 [Electronic] United States
• PMID: 23953402 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Chemical References

• Coloring Agents
• Indicators and Reagents
• Acetic Acid

Topics

• Acetic Acid
• Barrett Esophagus (pathology)
• Coloring Agents
• Esophagoscopy
• Esophagus (pathology)
• Female
• Humans
• Image-Guided Biopsy (methods)
• Indicators and Reagents
• Male
• Middle Aged
• Optical Imaging