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

Background: Traditional 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). Objective: We compared the efficacy of targeted biopsies that used i-scan or acetic acid to random biopsies in the detection of SCE. Design: Patients 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. Setting: Targeted biopsies were performed based on surface architecture according to the Guelrud classification followed by 4-quadrant biopsies. Patients: A total of 95 patients were randomized. Intervention: A total of 46 patients underwent acetic acid staining, and 49 underwent i-scan imaging. Random biopsies were performed in 86 patients. Main Outcome Measurements: The primary outcome was the yield of SCE as confirmed by histologic assessment. Results: The 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. Limitations: No dysplastic lesions were found. Conclusion: The 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.)