Acetic acid compared with i-scan imaging for detecting Barrett’s esophagus: a randomized, comparative trial

BackgroundTraditional 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).ObjectiveWe compared the efficacy of targeted biopsies that used i-scan or acetic acid to random biopsies in the detection of SCE.DesignPatients 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.SettingTargeted biopsies were performed based on surface architecture according to the Guelrud classification followed by 4-quadrant biopsies.PatientsA total of 95 patients were randomized.InterventionA total of 46 patients underwent acetic acid staining, and 49 underwent i-scan imaging. Random biopsies were performed in 86 patients.Main Outcome MeasurementsThe primary outcome was the yield of SCE as confirmed by histologic assessment.ResultsThe 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.LimitationsNo dysplastic lesions were found.ConclusionThe 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.)