Acetic acid chromoendoscopy doubled suspicious findings in Barrett's surveillance but found no more neoplasia

Design

Open-label stepped-wedge cluster randomised trial (ACID)

Population

2,267 people under Barrett's oesophagus surveillance at 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)

Hospitals switched in random order from standard surveillance to surveillance with acetic acid chromoendoscopy after training. Over 2,000 patients without known dysplasia were included.

Acetic acid more than doubled the proportion of patients with a suspected lesion but did not increase the rate of confirmed dysplasia or cancer.

Expert centres may get more from the technique, but in general practice of endoscopy it did not change what was found.

• 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.
• The setting was 18 community hospitals, not expert centres.

Why it matters

A technique that raises the lesion count without raising the cancer count adds biopsies and cost without benefit.

The statistics, in plain English

The odds ratio interval from 0.65 to 1.44 includes 1, so acetic acid showed no added detection. The extra suspicious areas were largely false alarms.

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