ACETIC-ACID IMPROVES IDENTIFICATION OF REMNANT ISLANDS OF BARRETTS EPITHELIUM AFTER ENDOSCOPIC THERAPY

Background: Instillation of acetic acid onto the uterine cervix at col poscopy has been used fear many years to highlight dysplastic areas an d thereby enhance the ability to obtain targeted biopsy specimens. As part of an ongoing trial of multipolar electrocoagulation for Barrett' s esophagus, we sought to develop a simple technique to identify small islands of residual specialized columnar epithelium after treatment. Methods: In 21 consecutive patients, 5 to 10 mt of 1.5% acetic acid wa s sprayed onto the distal esophagus using a spray catheter, followed i mmediately by spraying 50 mt of tap water. Results: Initially, a whiti sh coloration developed in both esophageal and gastric epithelia. Afte r 2 to 3 minutes, the esophageal squamous mucosa remained white but th e columnar epithelium became reddish. Remnant islands of Barrett's epi thelium were outlined by a white rim. Conclusion: Acetic acid instilla tion enhances the ability to detect small or indistinguishable remnant islands of columnar epithelium after endoscopic treatment of Barrett' s esophagus. This method is safe, rapid, and inexpensive.