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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2606-7682
Original article

Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study

Ilse N. Beaufort
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
2   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
Sjoerd G. Elias
3   Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
,
Elisabeth M.P. Akkerman
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
,
Anya N. Milne
4   Department of Pathology, St. Antonius Hospital, Nieuwegein, Netherlands
,
Lodewijk A. A. Brosens
5   Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
,
Marc A. M. T. Verhagen
6   Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, Netherlands
,
Lorenza Alvarez Herrero
2   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
Bas L. A. M. Weusten 
2   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
› Author Affiliations
Supported by: Sint Antonius Research Fund NA Clinical Trial: Registration number (trial ID): NCT05578677, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective, randomized, multicenter study
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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 (3.34 mm2 [95%CI 3.10–3.57] vs. 2.68 mm2 [95%CI 2.45–2.92]; P < 0.001). Mean (95%CI) biopsy size was 2.95 mm2 (2.72–3.19) and 3.08 mm2 (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 2.77 mm2 (2.44–3.09), 2.61 mm2 (2.29–2.93), 3.14 mm2 (2.81–3.46), and 3.54 mm2 (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 3.31 mm2 (2.95–3.68) to 3.90 mm2 (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.

Conclusion

BE surveillance biopsies should be taken with the single-biopsy method and turn-and-suction technique to increase biopsy size.

Supplementary Material



Publication History

Received: 09 October 2024

Accepted after revision: 05 March 2025

Article published online:
24 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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