Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis

Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer

“…After applying stringent selection criteria, a qualitative systematic review of 23 articles was performed, including one report on a meta‐analysis of surveillance by image‐enhanced endoscopy and nine cited references from the meta‐analysis . There were two articles on NBI, one on blue‐laser imaging (BLI), and one on a meta‐analysis of acetic acid, with nine cited references from the meta‐analysis …”

“…Regarding the diagnostic performance in terms of the sensitivity and specificity for detecting superficial cancer and dysplasia, NBI had a sensitivity of 94% (95% CI: 83–98%) and specificity of 94% (95% CI: 81–99%) (Table ), whereas the acetic acid method had a sensitivity of 92% (95% CI: 83–97%) and specificity of 96% (95% CI: 85–99%) (Table ), indicating excellent outcomes for both modalities. The ASGE proposed the criteria known as preservation and incorporation of valuable endoscopic innovations (PIVI) and reported that, for modalities with targeted biopsies, those with a sensitivity ≥90%, specificity ≥80%, and negative predictive value ≥98% were useful .…”

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

“…These clinical thresholds likely take into account factors such test performance, provider training, time, and cost, and provides a contextualized threshold to help develop evidence-based recommendations [23]. There is currently available data to support the use of VC and CC compared with other AIMs [24, 25]. In a systematic review and meta-analysis that included 14 studies, both VC and CC increased the diagnostic yield of dysplasia/ early EAC compared with random biopsies by 34% (95% CI 20–56) exceeding the minimum thresholds proposed for VC and CC in our study [26].…”

Challenges to diagnostic standardization of Barrett's esophagus in Asia

“…Multiple Asian and Western studies confirmed its efficacy in detecting IM as well as dysplastic lesions even in the setting of SSBE . A meta‐analysis showed that AA chromoendoscopy had a high diagnostic accuracy for high‐grade dysplasia and intramucosal cancer in BE, but, for specialized IM, there was high sensitivity but poor specificity . To address the problem of high intraobserver variability and low sensitivity among endoscopists unfamiliar with this technique, a simple classification for the detection of Barrett's neoplasia using AA, known as the Portsmouth AA classification (PREDICT), was developed and validated, showing high sensitivity and negative predictive value when applied by endoscopists and non‐endoscopists …”