Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5753-5760
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5753
Acetic acid chromoendoscopy: Improving neoplasia detection in Barrett's esophagus
Fergus J Q Chedgy, Sharmila Subramaniam, Kesavan Kandiah, Sreedhari Thayalasekaran, Pradeep Bhandari
Sharmila Subramaniam, Kesavan Kandiah, Sreedhari Thayalasekaran, Pradeep Bhandari, Fergus JQ Chedgy, Department of Gastroenterology, Queen Alexandra Hospital, PO6 3LY Portsmouth, United Kingdom
Author contributions: Chedgy FJQ was the lead author on the article and contributed to all sections of the manuscript and performed a literature review; Subramaniam S performed a literature review and wrote the section on acetic acid in the surveillance population; Kandiah K performed a literature review and wrote the section on acetic acid for the diagnosis of non-neoplastic Barrett’s esophagus; Thayalasekaran S performed a literature review and critically appraised the meta-analysis data of acetic acid for Barrett’s esophagus; Bhandari P provided critical revision of article and is senior author.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Pradeep Bhandari, MBBS, MD, FRCP, Department of Gastroenterology, Queen Alexandra Hospital, Southwick Hill Rd, PO6 3LY Portsmouth, United Kingdom.
Telephone: +44-2392-286255 Fax: +44-2392-286822
Received: March 11, 2016
Peer-review started: March 12, 2016
First decision: April 14, 2016
Revised: April 26, 2016
Accepted: May 23, 2016
Article in press: May 23, 2016
Published online: July 7, 2016

Barrett’s esophagus (BE) is an important condition given its significant premalignant potential and dismal five-year survival outcomes of advanced esophageal adenocarcinoma. It is therefore suggested that patients with a diagnosis of BE undergo regular surveillance in order to pick up dysplasia at an earlier stage to improve survival. Current “gold-standard” surveillance protocols suggest targeted biopsy of visible lesions followed by four quadrant random biopsies every 2 cm. However, this method of Barrett’s surveillance is fraught with poor endoscopist compliance as the procedures are time consuming and poorly tolerated by patients. There are also significant miss-rates with this technique for the detection of neoplasia as only 13% of early neoplastic lesions appear as visible nodules. Despite improvements in endoscope resolution these problems persist. Chromoendoscopy is an extremely useful adjunct to enhance mucosal visualization and characterization of Barrett’s mucosa. Acetic acid chromoendoscopy (AAC) is a simple, non-proprietary technique that can significantly improve neoplasia detection rates. This topic highlight summarizes the current evidence base behind AAC for the detection of neoplasia in BE and provides an insight into the direction of travel for further research in this area.

Keywords: Barrett’s esophagus, Acetic acid, Esophageal adenocarcinoma, Chromoendoscopy, Dysplasia

Core tip: Neoplasia detection in surveillance of Barrett’s esophagus (BE) remains challenging as current gold-standard four quadrant biopsies have a high miss-rate and are poorly adhered to. Evidence to support the use of acetic acid chromoendoscopy (AAC) is growing. We discuss the current evidence of AAC in BE and the direction of travel for future research.