Acetic acid spray is an effective tool for the endoscopic detection of neoplasia in patients with Barrett's esophagus

Clin Gastroenterol Hepatol. 2010 Oct;8(10):843-7. doi: 10.1016/j.cgh.2010.06.016. Epub 2010 Jun 30.


Background & aims: Diagnosis of Barrett's neoplasia requires collection of large numbers of random biopsy samples; the process is time consuming and can miss early-stage cancers. We evaluated the role of acetic acid chromoendoscopy in identifying Barrett's neoplasia.

Methods: Data were collected from patients with Barrett's esophagus examined at a tertiary referral center, between July 2005 and November 2008 using Fujinon gastroscopes and EPX 4400 processor (n = 190). All procedures were performed by a single experienced endoscopist. Patients were examined with white light gastroscopy and visible abnormalities were identified. Acetic acid (2.5%) dye spray was used to identify potentially neoplastic areas and biopsy samples were collected from these, followed by quadrantic biopsies at 2 cm intervals of the remaining Barrett's mucosa. The chromoendoscopic diagnosis was compared with the ultimate histological diagnosis to evaluate the sensitivity of acetic acid chromoendoscopy.

Results: Acetic acid chromoendoscopy had a sensitivity of 95.5% and specificity of 80% for the detection of neoplasia. There was a correlation between lesions predicted to be neoplasias by acetic acid and those diagnosed by histological analysis (r = 0.98). There was a significant improvement in the detection of neoplasia using acetic acid compared with white light endoscopy (P = .001).

Conclusions: Analysis of this large series showed that acetic acid-assisted evaluation of Barrett's esophagus detects neoplasia better than white light endoscopy, with sensitivity and specificity equal to that of histological analysis.

Publication types

  • Evaluation Study

MeSH terms

  • Acetic Acid*
  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / complications*
  • Barrett Esophagus / diagnosis*
  • Biopsy / methods
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / pathology*
  • Female
  • Gastroscopy / methods*
  • Histocytochemistry
  • Humans
  • Male
  • Microscopy
  • Middle Aged
  • Sensitivity and Specificity


  • Acetic Acid