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Acetic acid guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): a feasibility study for a randomised tandem endoscopy trial. The ABBA study

Acetic acid guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): a feasibility study for a randomised tandem endoscopy trial. The ABBA study
Acetic acid guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): a feasibility study for a randomised tandem endoscopy trial. The ABBA study
Background and study aims - Barrett’s esophagus is a potentially pre-cancerous condition, affecting 375,000 people in the UK. Patients receive a 2-yearly endoscopy to detect cancerous changes, as early detection and treatment results in better outcomes. Current treatment requires random mapping biopsies along the length of Barrett’s, in addition to biopsy of visible abnormalities. As only 13 % of precancerous changes appear as visible nodules or abnormalities, areas of dysplasia are often missed. Acetic acid chromoendoscopy (AAC) has been shown to improve detection of pre-cancerous and cancerous tissue in observational studies, but no randomized controlled trials (RCTs) have been performed to date. Patients and methods - A “tandem” endoscopy cross-overdesign. Participants will be randomized to endoscopy usingmapping biopsies or AAC, in which dilute acetic acid issprayed onto the surface of the esophagus, highlighting tissuethrough an whitening reaction and enhancing visibilityof areas with cellular changes for biopsy. After 4 to 10weeks, participants will undergo a repeat endoscopy, usingthe second method. Rates of recruitment and retention willbe assessed, in addition to the estimated dysplasia detectionrate, effectiveness of the endoscopist training program,and rates of adverse events (AEs). Qualitative interviewswill explore participant and endoscopist acceptabilityof study design and delivery, and the acceptability ofswitching endoscopic techniques for Barrett's surveillance. Results - Endoscopists’ ability to diagnose dysplasia in Barrett’sesophagus can be improved. AAC may offer a simple,universally applicable, easily-acquired technique to improvedetection, affording patients earlier diagnosis and treatment,reducing endoscopy time and pathology costs. TheABBA study will determine whether a crossover “tandem”endoscopy design is feasible and acceptable to patientsand clinicians and gather outcome data to power a definitivetrial.
oesophageal cancer, gastroscopy, surveillance
2364-3722
E43-E50
Chedgy, Fergus
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Fogg, Carole
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Kandiah, Kesavan
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Barr, Hugh
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Higgins, Bernie
dac0fccb-8fc9-496e-85fb-f98c55e1ba56
McCord, Mimi
68120f1f-0786-4e4e-bb6a-2445d2e42b57
Dewey, Ann
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De Caestecker, John
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Gadeke, Lisa
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Stokes, Clive
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Poller, David
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Longcroft-Wheaton, Gaius
c81264ad-35a8-4601-a001-d7cfb6357863
Bhandari, Pradeep
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Chedgy, Fergus
143cea93-6dbc-474c-ba84-d70b7396993a
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Kandiah, Kesavan
65a0a577-cb0b-4b9c-b1b5-d44d4a266285
Barr, Hugh
d9616fd6-936c-40c5-a4b8-ec37ae3d3bde
Higgins, Bernie
dac0fccb-8fc9-496e-85fb-f98c55e1ba56
McCord, Mimi
68120f1f-0786-4e4e-bb6a-2445d2e42b57
Dewey, Ann
e0734bf3-5ad8-4c6b-8658-089a3b7d36d2
De Caestecker, John
b40f6165-1385-446e-993d-5487bf2b77fa
Gadeke, Lisa
c1d969f6-7026-4b55-8e60-94968a3eea73
Stokes, Clive
67a5dac8-8434-4648-bcba-6dd7c62113b5
Poller, David
25853959-8abc-4e5d-8f9c-1bb02012a11c
Longcroft-Wheaton, Gaius
c81264ad-35a8-4601-a001-d7cfb6357863
Bhandari, Pradeep
5d6f89f0-a69d-48d7-b182-95e7f400e1c9

Chedgy, Fergus, Fogg, Carole, Kandiah, Kesavan, Barr, Hugh, Higgins, Bernie, McCord, Mimi, Dewey, Ann, De Caestecker, John, Gadeke, Lisa, Stokes, Clive, Poller, David, Longcroft-Wheaton, Gaius and Bhandari, Pradeep (2018) Acetic acid guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): a feasibility study for a randomised tandem endoscopy trial. The ABBA study. Endoscopy International Open, 06 (01), E43-E50. (doi:10.1055/s-0043-120829).

Record type: Article

Abstract

Background and study aims - Barrett’s esophagus is a potentially pre-cancerous condition, affecting 375,000 people in the UK. Patients receive a 2-yearly endoscopy to detect cancerous changes, as early detection and treatment results in better outcomes. Current treatment requires random mapping biopsies along the length of Barrett’s, in addition to biopsy of visible abnormalities. As only 13 % of precancerous changes appear as visible nodules or abnormalities, areas of dysplasia are often missed. Acetic acid chromoendoscopy (AAC) has been shown to improve detection of pre-cancerous and cancerous tissue in observational studies, but no randomized controlled trials (RCTs) have been performed to date. Patients and methods - A “tandem” endoscopy cross-overdesign. Participants will be randomized to endoscopy usingmapping biopsies or AAC, in which dilute acetic acid issprayed onto the surface of the esophagus, highlighting tissuethrough an whitening reaction and enhancing visibilityof areas with cellular changes for biopsy. After 4 to 10weeks, participants will undergo a repeat endoscopy, usingthe second method. Rates of recruitment and retention willbe assessed, in addition to the estimated dysplasia detectionrate, effectiveness of the endoscopist training program,and rates of adverse events (AEs). Qualitative interviewswill explore participant and endoscopist acceptabilityof study design and delivery, and the acceptability ofswitching endoscopic techniques for Barrett's surveillance. Results - Endoscopists’ ability to diagnose dysplasia in Barrett’sesophagus can be improved. AAC may offer a simple,universally applicable, easily-acquired technique to improvedetection, affording patients earlier diagnosis and treatment,reducing endoscopy time and pathology costs. TheABBA study will determine whether a crossover “tandem”endoscopy design is feasible and acceptable to patientsand clinicians and gather outcome data to power a definitivetrial.

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Accepted/In Press date: 30 June 2017
Published date: 12 January 2018
Keywords: oesophageal cancer, gastroscopy, surveillance

Identifiers

Local EPrints ID: 437044
URI: http://eprints.soton.ac.uk/id/eprint/437044
ISSN: 2364-3722
PURE UUID: 65b1ba20-17b7-43f0-bda4-0bc57c86657c
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185

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Date deposited: 15 Jan 2020 17:39
Last modified: 17 Mar 2024 03:56

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Contributors

Author: Fergus Chedgy
Author: Carole Fogg ORCID iD
Author: Kesavan Kandiah
Author: Hugh Barr
Author: Bernie Higgins
Author: Mimi McCord
Author: Ann Dewey
Author: John De Caestecker
Author: Lisa Gadeke
Author: Clive Stokes
Author: David Poller
Author: Gaius Longcroft-Wheaton
Author: Pradeep Bhandari

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