Design: Prospective, open-label, stepped-wedge cluster randomised trial
Population: 2,267 people under Barrett's surveillance in 18 community hospitals
Primary outcome: Neoplasia detection rate in any biopsy
Effect: 7.4% vs 7.1%; OR 0.97 (95% CI 0.65–1.44)

A stepped-wedge cluster randomised trial in 18 Dutch community hospitals moved Barrett's surveillance from standard endoscopy to endoscopy with acetic acid chromoendoscopy, after training endoscopists. It included 2,267 people without known dysplasia.

Neoplasia was found in 7.4% with acetic acid versus 7.1% without (OR 0.97, 95% CI 0.65–1.44). Suspected lesions were flagged in 14.0% versus 6.4%, but targeted biopsies found neoplasia no more often (2.1% vs 1.8%).

The technique more than doubled the number of areas that looked suspicious without improving yield. In routine community practice, that means more biopsies and more anxiety for no detection gain. The result does not speak to expert centres, where the technique may perform differently.

Acetic acid chromoendoscopy did not improve neoplasia detection in routine Barrett's surveillance
It more than doubled the number of suspicious areas flagged
Random four-quadrant biopsies remain part of standard surveillance
The result applies to community hospitals, not necessarily expert centres

Why it matters

An add-on that raises suspicion without raising yield costs biopsies and patient worry.

The statistics, in plain English

An odds ratio of 0.97 with a confidence interval from 0.65 to 1.44 means the trial found no difference and cannot rule out a modest effect either way.