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Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video).
Gastrointest Endosc 2014; 80(3):417-24GE

Abstract

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.

DESIGN

Retrospective cohort study.

SETTING

Tertiary referral hospital in the United Kingdom.

PATIENTS

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

INTERVENTIONS

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

MAIN OUTCOME MEASUREMENTS

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).

LIMITATIONS

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.

Authors+Show Affiliations

Queen Alexandra Hospital, Portsmouth, United Kingdom.Queen Alexandra Hospital, Portsmouth, United Kingdom.Queen Alexandra Hospital, Portsmouth, United Kingdom.Queen Alexandra Hospital, Portsmouth, United Kingdom.Queen Alexandra Hospital, Portsmouth, United Kingdom.

Pub Type(s)

Comparative Study
Journal Article
Video-Audio Media

Language

eng

PubMed ID

24713305

Citation

Tholoor, Shareef, et al. "Acetic Acid Chromoendoscopy in Barrett's Esophagus Surveillance Is Superior to the Standardized Random Biopsy Protocol: Results From a Large Cohort Study (with Video)." Gastrointestinal Endoscopy, vol. 80, no. 3, 2014, pp. 417-24.
Tholoor S, Bhattacharyya R, Tsagkournis O, et al. Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). Gastrointest Endosc. 2014;80(3):417-24.
Tholoor, S., Bhattacharyya, R., Tsagkournis, O., Longcroft-Wheaton, G., & Bhandari, P. (2014). Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). Gastrointestinal Endoscopy, 80(3), pp. 417-24. doi:10.1016/j.gie.2014.01.041.
Tholoor S, et al. Acetic Acid Chromoendoscopy in Barrett's Esophagus Surveillance Is Superior to the Standardized Random Biopsy Protocol: Results From a Large Cohort Study (with Video). Gastrointest Endosc. 2014;80(3):417-24. PubMed PMID: 24713305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). AU - Tholoor,Shareef, AU - Bhattacharyya,Rupam, AU - Tsagkournis,Orestis, AU - Longcroft-Wheaton,Gaius, AU - Bhandari,Pradeep, Y1 - 2014/04/06/ PY - 2013/08/07/received PY - 2014/01/22/accepted PY - 2014/4/10/entrez PY - 2014/4/10/pubmed PY - 2015/5/12/medline SP - 417 EP - 24 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 80 IS - 3 N2 - 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. DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital in the United Kingdom. PATIENTS: Patients 18 years of age and older with a diagnosis of Barrett's esophagus undergoing surveillance gastroscopy. INTERVENTIONS: AAC versus standardized random biopsy protocol (SBP) for Barrett's esophagus surveillance. MAIN OUTCOME MEASUREMENTS: 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). LIMITATIONS: 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/24713305/Acetic_acid_chromoendoscopy_in_Barrett's_esophagus_surveillance_is_superior_to_the_standardized_random_biopsy_protocol:_results_from_a_large_cohort_study__with_video__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(14)00105-9 DB - PRIME DP - Unbound Medicine ER -