- Design
- Open-label, stepped-wedge cluster randomised trial (ACID)
- Population
- 2,267 people under Barrett's surveillance without known dysplasia, 18 Dutch community hospitals
- Primary outcome
- Neoplasia detection rate in any biopsy
- Effect
- 7.4% vs 7.1%; OR 0.97 (95% CI 0.65 to 1.44)
Eighteen Dutch community hospitals switched, in random order, from standard Barrett's surveillance to surveillance with acetic acid chromoendoscopy after training their endoscopists. All patients also had four-quadrant biopsies.
Acetic acid more than doubled the number of patients with a suspected lesion but did not increase the proportion with confirmed dysplasia or cancer, either overall or in targeted biopsies.
The practical message for community endoscopy is to invest in inspection time and biopsy protocol rather than adjunct staining.
- Neoplasia detection was 7.4% with acetic acid and 7.1% without.
- Suspected lesions were flagged in 14% with acetic acid against 6% without.
- Targeted biopsy yield was not higher with acetic acid.
- About 1% of patients had oesophageal adenocarcinoma at surveillance.
- Endoscopists were trained before implementation, so lack of training does not explain the null result.
Why it matters
It removes a step that many units were adopting, and saves the extra biopsies that suspicious but benign findings generate.
Don't overread it
The trial was in community hospitals; expert centres may still find value in acetic acid for characterising known lesions.
The statistics, in plain English
The odds ratio interval from 0.65 to 1.44 includes 1, so no added detection was shown. Only 82% of those allocated to acetic acid received it, which slightly dilutes the comparison.
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