Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study

Abstract

Background The impact of different random biopsy techniques for Barrett esophagus (BE) surveillance on histopathological quality is unclear. We compared the double-vs. single-biopsy method and advance-and-close vs. turn- and-suction technique. Methods In a multicenter, factorial design trial (Part I), BE patients were randomly assigned to the double- or single-biopsy method and advance-and-close or turn-and-suction technique (1:1:1:1). In a before–after study (Part II), the optimal biopsy method and technique were implemented in clinical practice. The primary end point in both parts was biopsy size. Results In Part I (107 patients, 1024 biopsies), single-method biopsies were 25% larger than double-method biopsies (3.34mm2 [95%CI 3.10–3.57] vs. 2.68mm2 [95% CI 2.45–2.92]; P<0.001). Mean (95%CI) biopsy size was 2.95mm2 (2.72–3.19) and 3.08mm2 (2.85–3.31) with advance-and-close and turn-and-suction techniques, respectively (P=0.44). The interaction term between the co-primary comparisons was P=0.08. Mean (95%CI) biopsy size for double-biopsy + advance-and-close, double-biopsy + turn-and-suction, single-biopsy + advance-and-close, and single-biopsy + turn-and-suction was 2.77mm2 (2.44–3.09), 2.61mm2 (2.29–2.93), 3.14mm2 (2.81–3.46), and 3.54mm2 (3.22–3.86), respectively. In Part II, 46 and 44 patients were included before and after implementation of the single-biopsy method and turn-and-suction technique, in whom this combination was used in 16/46 (35%) and 44/ 44 (100%) patients, respectively. Mean (95%CI) biopsy size increased by 18%, from 3.31mm2 (2.95–3.68) to 3.90mm2 (3.50–4.29; P=0.03). Conclusion BE surveillance biopsies should be taken with the single-biopsy method and turn-and-suction technique to increase biopsy size.