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Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design.
Gastrointest Endosc. 2006 Jul; 64(1):1-8.GE

Abstract

BACKGROUND

In contrast to standard video endoscopy, magnifying endoscopy after local acetic acid application enables recognition of mucosal surface architecture.

OBJECTIVE

To investigate the diagnostic yield of magnifying endoscopy with acetic acid-targeted biopsies compared to random, 4-quadrant biopsies.

DESIGN

Prospective randomized trial (ratio 1:1) with crossover design.

SETTING

Two referral hospitals in Germany.

PATIENTS

Thirty-one patients with Barrett's esophagus or visible columnar-lined lower esophagus.

INTERVENTIONS

Patients were randomized to undergo either standard video endoscopy with 4-quadrant biopsies or magnifying endoscopy in conjunction with acetic acid application. All patients were re-examined 14 days after the initial endoscopy with the corresponding procedure.

MAIN OUTCOME MEASUREMENTS

Primary outcome analysis (per protocol and per biopsy) was the histological proof of Barrett's epithelium. Secondary outcome analysis was the correlation between the surface architecture and the presence of Barrett's epithelium and the needed number of biopsies to confirm Barrett's epithelium for the 2 different procedures.

RESULTS

Magnifying endoscopy enabled the prediction of Barrett's epithelium with a sensitivity of 100% and a specificity of 66%, respectively (accuracy 83.8%). Acetic acid-guided biopsies obtained a significantly higher percentage of tissues containing SCE (78%; 188/241) compared to random biopsies (57%; 159/280).

LIMITATIONS

No data on the diagnosis of Barrett's dysplasia.

CONCLUSION

Magnifying endoscopy with acetic acid-guided biopsies is superior to standard video endoscopy with random biopsies, and the number of biopsies needed to confirm Barrett's epithelium is half as much when compared to random biopsies.

Authors+Show Affiliations

I Med. Clinic und Poliklinik, Institute for Statistics, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

16813794

Citation

Hoffman, A, et al. "Acetic Acid-guided Biopsies After Magnifying Endoscopy Compared With Random Biopsies in the Detection of Barrett's Esophagus: a Prospective Randomized Trial With Crossover Design." Gastrointestinal Endoscopy, vol. 64, no. 1, 2006, pp. 1-8.
Hoffman A, Kiesslich R, Bender A, et al. Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design. Gastrointest Endosc. 2006;64(1):1-8.
Hoffman, A., Kiesslich, R., Bender, A., Neurath, M. F., Nafe, B., Herrmann, G., & Jung, M. (2006). Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design. Gastrointestinal Endoscopy, 64(1), 1-8.
Hoffman A, et al. Acetic Acid-guided Biopsies After Magnifying Endoscopy Compared With Random Biopsies in the Detection of Barrett's Esophagus: a Prospective Randomized Trial With Crossover Design. Gastrointest Endosc. 2006;64(1):1-8. PubMed PMID: 16813794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design. AU - Hoffman,A, AU - Kiesslich,R, AU - Bender,A, AU - Neurath,M F, AU - Nafe,B, AU - Herrmann,G, AU - Jung,M, PY - 2005/04/30/received PY - 2005/09/13/accepted PY - 2006/7/4/pubmed PY - 2006/9/6/medline PY - 2006/7/4/entrez SP - 1 EP - 8 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 64 IS - 1 N2 - BACKGROUND: In contrast to standard video endoscopy, magnifying endoscopy after local acetic acid application enables recognition of mucosal surface architecture. OBJECTIVE: To investigate the diagnostic yield of magnifying endoscopy with acetic acid-targeted biopsies compared to random, 4-quadrant biopsies. DESIGN: Prospective randomized trial (ratio 1:1) with crossover design. SETTING: Two referral hospitals in Germany. PATIENTS: Thirty-one patients with Barrett's esophagus or visible columnar-lined lower esophagus. INTERVENTIONS: Patients were randomized to undergo either standard video endoscopy with 4-quadrant biopsies or magnifying endoscopy in conjunction with acetic acid application. All patients were re-examined 14 days after the initial endoscopy with the corresponding procedure. MAIN OUTCOME MEASUREMENTS: Primary outcome analysis (per protocol and per biopsy) was the histological proof of Barrett's epithelium. Secondary outcome analysis was the correlation between the surface architecture and the presence of Barrett's epithelium and the needed number of biopsies to confirm Barrett's epithelium for the 2 different procedures. RESULTS: Magnifying endoscopy enabled the prediction of Barrett's epithelium with a sensitivity of 100% and a specificity of 66%, respectively (accuracy 83.8%). Acetic acid-guided biopsies obtained a significantly higher percentage of tissues containing SCE (78%; 188/241) compared to random biopsies (57%; 159/280). LIMITATIONS: No data on the diagnosis of Barrett's dysplasia. CONCLUSION: Magnifying endoscopy with acetic acid-guided biopsies is superior to standard video endoscopy with random biopsies, and the number of biopsies needed to confirm Barrett's epithelium is half as much when compared to random biopsies. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/16813794/Acetic_acid_guided_biopsies_after_magnifying_endoscopy_compared_with_random_biopsies_in_the_detection_of_Barrett's_esophagus:_a_prospective_randomized_trial_with_crossover_design_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(05)02929-9 DB - PRIME DP - Unbound Medicine ER -