Acetic acid compared with i-scan imaging for detecting Barrett’s esophagus: a randomized, comparative trial - 15/12/13
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.)
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CLE, NBI, SCE
Plan
| DISCLOSURE: This study is an investigator-initiated trial. However, R. Kiesslich received an unrestricted grant (2008-2013) from Pentax Europe to perform clinical studies with the focus on endoscopy. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Hoffman at a.hoffman@katharina-kasper.de. |
Vol 79 - N° 1
P. 46-54 - janvier 2014 Retour au numéro
Article précédent
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