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

Gastrointest Endosc. 2014 Jan;79(1):46-54. doi: 10.1016/j.gie.2013.07.013. Epub 2013 Aug 14.


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.).

Keywords: BE; Barrett’s esophagus; CLE; NBI; SCE; columnar-lined lower esophagus or columnar-lined epithelium; narrow-band imaging; specialized columnar epithelium.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetic Acid*
  • Barrett Esophagus / pathology*
  • Coloring Agents
  • Esophagoscopy
  • Esophagus / pathology*
  • Female
  • Humans
  • Image-Guided Biopsy / methods
  • Indicators and Reagents*
  • Male
  • Middle Aged
  • Optical Imaging*


  • Coloring Agents
  • Indicators and Reagents
  • Acetic Acid

Associated data