2859 Acetic Acid Chromoendoscopy in Barrett’s Esophagus Surveillance Is Superior to the Standardized Random Biopsy Protocol in Detecting Neoplasia: A Prospective Randomized Trial in a Community Setting

Abstract

INTRODUCTION: Barrett's esophagus (BE) is the most important precursor lesion and risk factor for development of esophageal adenocarcinoma (EAC) with annual risk of 0.12–0.5%. Surveillance endoscopy with random biopsies of Barrett’s tissue at established intervals is recommended. Targeted biopsies may eliminate the need for random biopsies. Those found with earlier neoplasia during surveillance have the best prognosis. Acetic acid chromoendoscopy (AAC) has been found to be useful in increasing the yield of neoplasia detection during BE surveillance. Use of AAC in a community setting has not been investigated. METHODS: A prospective randomized clinical trial was done including patients 18 years and older with confirmed diagnosis of BE in a community setting in a South Texas gastroenterology office. A total of 104 patients were required. Patients from two gastroenterologists were included. Patients were recruited from a BE Surveillance Program and were screened via medical chart reviews. Exclusion criteria included history of esophageal ulcerations, esophageal Candida, esophageal varices, history of dysplasia, and history of ablation therapy. Patients were randomized into two groups. The intervention arm had the esophageal mucosa sprayed with 10cc of 2.5% acetic acid solution before inspection and biopsy. The control group underwent random biopsies as per guidelines. RESULTS: A total of 61 patients were enrolled and 30 were excluded including 18 due to negative biopsies, 10 due to missed appointments, and 2 due to esophagitis. A total of 31 patients were randomized (Acetic Acid n = 20, Control n = 11) and of these 1 patient had EAC at the target site [Acetic Acid n = 1 (5%), Control n = 0 (0%)]. It was found that 78% of the sample were patients with short segment BE (SSBE). Results suggested that the study was under-powered. A total of 1176 (Acetic Acid n = 588, Control n = 588) patients would be required in order for the study to have sufficient power to be statistically significant. The sample sizes required were not feasible for a single community practice; therefore, the study was discontinued. CONCLUSION: Our study was halted due to lack of sample power required to prove the hypothesis. The prevalence of neoplasia in our community was low given the high percentage of enrolled patients with SSBE. In order to validate this cost-effective technique in a community setting in the United States, a randomized trial with a larger collective effort involving multiple community centers will be required.