Acetic acid chromoendoscopy for detection of neoplastic Barrett's oesophagus: stepped wedge cluster randomised controlled trial (ACID-trial).
I N Beaufort, L S Boer, A N Milne et al.
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In 30 seconds
This prospective, open-label, stepped-wedge cluster randomised trial assessed whether acetic acid chromoendoscopy (AAC) improved detection of dysplasia or oesophageal adenocarcinoma during Barrett’s oesophagus surveillance in 18 Dutch community hospitals. Among 2267 participants, neoplasia detection was similar with and without AAC: 7.4% (50/679) versus 7.1% (113/1588), respectively (adjusted odds ratio 0.97, 95% confidence interval 0.65 to 1.44). AAC increased the proportion with suspected lesions, but did not increase neoplasia detection in targeted biopsies.
Key findings
- Overall neoplasia detection was 7.4% (50/679) with AAC versus 7.1% (113/1588) without AAC; adjusted odds ratio 0.97, 95% confidence interval 0.65 to 1.44.
- Suspected lesions were identified in 14.0% with AAC versus 6.4% without AAC (P<0.001).
- Targeted biopsy neoplasia detection was 2.1% (14/679) with AAC versus 1.8% (29/1588) without AAC; odds ratio 1.05, 0.49 to 2.24.
Why it matters
The trial evaluates an added endoscopic technique in routine Barrett’s surveillance and distinguishes increased visual suspicion from improved detection of confirmed neoplasia. In this setting, more suspected lesions did not translate into a higher overall or targeted-biopsy detection rate, an important consideration when assessing the value of additional surveillance procedures.
What to keep in mind
AAC was applied in 679 of 829 participants allocated to the intervention, so implementation was incomplete. The trial was open label and conducted in Dutch community hospitals.