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
; 80(3): 417-24, 2014 Sep.
Article
em En
| MEDLINE
| ID: mdl-24713305
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Esôfago de Barrett
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Neoplasias Esofágicas
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Adenocarcinoma
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Endoscopia do Sistema Digestório
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Ácido Acético
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Indicadores e Reagentes
Tipo de estudo:
Etiology_studies
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Guideline
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Incidence_studies
/
Observational_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Gastrointest Endosc
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Reino Unido