Acetic Acid Chromoendoscopy Improved Detection of Islands of Barrett's Epithelium in GERD Patients

Abstract

Purpose: The diagnosis of Barrett's esophagus by endoscopy could be difficult by visual inspection. The methylene blue stain already used for improving endoscopic surveillance in Barrett's esophagus. But sensitivity of staining is significantly affected by esophagitis. Acetic acid produces reversible intracellular cytoplasmic protein denaturation and differentiates Barrett's epithelium from squamous epithelium in gastroesophageal junction. The sensitivity of acetic acid chromoscopy for islands of Barrett's epithelium is unexplored in GERD patients. The aim of study is to investigate the diagnostic yield of acetic acid staining for Barrett's epithelium in GERD patients. Methods: We prospectively evaluate the accuracy and diagnostic yield of acetic acid directed biopsy in detecting island of Barrett's epithelium in GERD patients. Chromoendoscopy of the distal esophagus with 1.5% acetic acid was performed on 78 patients and 10 healthy volunteers. We obtained 91 biopsy specimens from GERD patients and 10 biopsy specimens from healthy volunteers. Results: Acetic acid staining specimens were 85 of 101 specimens (84.2%). The overall accuracy of acetic acid staining for detecting Barrett epithelium was 80.2%. In visual inspection, the overall accuracy of Barrett's islands was 48.4%. Acetic acid unstaining specimens for diagnosed as reflux esophagitis and healthy volunteers were 13 of 16(81.3%) specimens. The, sensitivity, specificity, positive and negative predictive value of acetic acid chromoscopy were 95.8%, 43.3%, 80.0%, and 81.3%, respectively. Conclusion: Acetic acid chromoscopy increased diagnostic accuracy for detection of island of Barrett's epithelium in GERD patients.