Gastroenterology · 3 h ago
Acetic acid chromoendoscopy did not improve neoplasia detection in Barrett’s surveillance
In a stepped-wedge cluster randomised trial across 18 Dutch community hospitals, 2,267 patients undergoing Barrett’s oesophagus surveillance were assessed with or without acetic acid chromoendoscopy (AAC). AAC did not increase overall neoplasia detection, despite more suspected lesions being identified.
- Trial included 2,267 patients at 18 Dutch hospitals.
- Overall neoplasia detection was similar with and without AAC.
- AAC identified more suspected lesions, but not more targeted neoplasia.
This prospective, open-label, stepped-wedge cluster randomised trial assessed whether adding acetic acid chromoendoscopy (AAC) improved detection of dysplasia or oesophageal adenocarcinoma during Barrett’s oesophagus surveillance. It included 2,267 patients at 18 Dutch community hospitals; patients with known or previously treated dysplasia were excluded. Hospitals shifted from standard surveillance to AAC, with targeted biopsies of visible lesions and random four-quadrant biopsies in both groups.
Neoplasia was diagnosed in 163 participants (7.2%). The detection rate was 7.4% with AAC (50/679) and 7.1% without AAC (113/1,588; adjusted odds ratio 0.97, 95% confidence interval 0.65 to 1.44). AAC led to more suspected lesions being identified (14.0% vs 6.4%), but targeted biopsy detection was similar: 2.1% versus 1.8% (odds ratio 1.05, 95% CI 0.49 to 2.24).
In this routine-care trial, AAC did not improve neoplasia detection. The findings apply to the studied surveillance setting and excluded patients with known or previously treated dysplasia. The trial was prospectively registered; the supplied abstract does not report funding or other limitations.
In practice
For patients undergoing Barrett’s oesophagus surveillance without known or previously treated dysplasia, this trial found no improvement in overall neoplasia detection when acetic acid chromoendoscopy was added to routine endoscopy. Although AAC increased the proportion in whom lesions were suspected, targeted biopsy detection was not higher. These findings from 18 Dutch community hospitals do not support an expectation of improved detection from AAC in this setting; applicability to other populations or surveillance protocols is not established by the supplied abstract.
AI-generated clinical interpretation · Not editor-reviewed
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The BMJ: Acetic acid chromoendoscopy for detection of neoplastic Barrett’s oesophagus: stepped wedge cluster randomised controlled trial (ACID-trial) ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.