Acetic acid chromoendoscopy does not improve cancer detection in Barrett’s oesophagus

1. Acetic acid chromoendoscopy did not improve the overall or targeted neoplasia detection rate in patients with Barrett’s oesophagus undergoing endoscopic surveillance in routine clinical practice.

Evidence Rating Level: 1 (Excellent)

Previous studies have found acid chromoendoscopy (AAC) to have promising diagnostic value in the surveillance of Barrett’s oesophagus. Although AAC-guided surveillance has been suggested to increase neoplasia detection rate in patients at high risk in Barrett’s oesophagus expert centres, its added value in routine clinical practice is unclear. This study thus examined the added value of AAC for the detection of neoplasia during Barrett’s oesophagus surveillance endoscopies in routine clinical care. This randomised clinical trial included patients >18 years old undergoing surveillance for Barrett’s oesophagus in the Netherlands. Participating hospitals sequentially shifted from surveillance without AAC (control) to AAC (intervention) in a randomised order. The primary outcome was the neoplasia detection rate. Out of the 2267 participants included in the study, 1438 (63%) were allocated to surveillance without AAC and 829 (37%) to surveillance with AAC, of whom 679 (82%) of actually received AAC. Neoplasia was diagnosed in 163 (7.2%) participants. Surveillance with AAC did not increase the neoplasia detection rate compared with surveillance without AAC (7.4% vs 7.1%; odds ratio [OR], 0.97; 95% CI, 0.65 to 1.44). Although more suspected lesions were detected in participants receiving surveillance with AAC compared to without AAC (14.0% vs 6.4%, P<0.001), the targeted neoplasia detection rate was similar between groups (2.1% vs 1.8%; OR 1.05, 0.49 to 2.24). Overall, this study found that AAC use did not improve the overall or targeted neoplasia detection rate among patients with Barrett’s oesophagus undergoing endoscopic surveillance. These findings suggest that AAC does not provide added value in routine clinical practice.

Click here to read this study in the BMJ

Citation: Beaufort IN, Boer LS, Milne AN, Alderlieste YA, Baars JE, Bos PR, et al. Acetic acid chromoendoscopy for detection of neoplastic Barrett's oesophagus: stepped wedge cluster randomised controlled trial (ACID-trial). BMJ. 2026 Oct 21;395:e100872. doi: 10.1136/bmj-2026-100872. PMID: 42907095.

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