A FEASIBILITY STUDY OF PATIENT AND CLINICIAN ACCEPTABILITY OF ACETIC-ACID CHROMOENDOSCOPY FOR BARRETT'S SURVEILLANCE: ABBA

Aims:

Acetic acid (AA) can identify neoplasia so biopsies can be targeted and avoided if no neoplasia is seen. This is a huge change from conventional non-targeted mapping biopsies. This study aims to assess patient acceptability of these different biopsy strategies.

Methods:

Mixed-method multicentre randomized crossover study. Patients under surveillance for Barrett's metaplasia had two gastroscopies 8 weeks apart, one with AA guided biopsy of abnormal areas only (Portsmouth Protocol) and one with non-targeted mapping biopsies (Seattle Protocol). Recruitment and retention was assessed. Qualitative telephone interviews were conducted with participants, patients who declined, and clinicians to explore experience, acceptance, barriers and enablers to study participation and implementation of the technique. Qualitative sampling continued until data saturation was attained, thematic analysis was used.

Results:

200 patients (145 male) consented to participate. 192 completed at least one procedure with 175 completing both procedures. No serious adverse events reported. We interviewed 21 participants to achieve data saturation, 6 non-participants and 6 clinicians (1/site). Of the 6 non-participants, half declined to participate due to fear of a second procedure. Participants said the AA procedure seemed simpler, quicker with less pain, soreness and bleeding afterwards, and that future use of the technique could give more immediate results, providing reassurance or leading to more rapid treatment. Clinicians found the technique easy to implement following training, and noted decreased discomfort for patients. Remaining concerns regarding missed pathology until a definitive trial is performed necessitates use of a crossover design in future studies.

Conclusions:

The high level of consent and attendance of both procedures demonstrated that inclusion of the AA procedure and the crossover study design are feasible components for a definitive trial. Participants and clinicians found the study design and use of AA technique acceptable. No insurmountable barriers to implementation were identified, pending proof of efficacy of the AA technique.