Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study.

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Histopathology

Background:

• The optimal random biopsy technique for Barrett esophagus (BE) surveillance remains unclear.
• Histopathological quality is crucial for accurate BE diagnosis and management.
• Different biopsy methods and techniques may impact specimen size and quality.

Purpose of the Study:

• To compare the impact of single- vs. double-biopsy methods on histopathological quality in BE surveillance.
• To evaluate the efficacy of advance-and-close vs. turn-and-suction biopsy techniques.
• To determine the optimal biopsy strategy for maximizing biopsy size in BE surveillance.

Main Methods:

• A multicenter, factorial design trial (Part I) randomized BE patients to single or double biopsy methods and advance-and-close or turn-and-suction techniques.
• A before-after study (Part II) implemented the optimal biopsy method and technique in clinical practice.
• The primary endpoint for both parts was biopsy size.

Main Results:

• In Part I, single-method biopsies were 25% larger than double-method biopsies (3.34 mm² vs. 2.68 mm²; P < 0.001).
• The turn-and-suction technique showed no significant difference in biopsy size compared to advance-and-close (P = 0.44).
• In Part II, implementing the single-biopsy method and turn-and-suction technique increased mean biopsy size by 18% (P = 0.03).

Conclusions:

• The single-biopsy method is superior to the double-biopsy method for increasing biopsy size in BE surveillance.
• The turn-and-suction technique, when combined with the single-biopsy method, maximizes biopsy size.
• Adoption of the single-biopsy method and turn-and-suction technique is recommended to enhance histopathological quality in BE surveillance.