SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2016/01  
 
  2016 Jan;83(1):57-67.e1  
  doi: 10.1016/j.gie.2015.07.023. Epub 2015 Sep 12.  
 
  Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis  
 
  Coletta M, Sami SS, Nachiappan A, Fraquelli M, Casazza G, Ragunath K  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Acetic+acid+chromoendoscopy+for+the+diagnosis+of+early+neoplasia+and+specialized+intestinal+metaplasia+in+Barrett%E2%80%99s+esophagus%3A+a+meta-analysis  
 
 

BACKGROUND AND AIMS:

Barrett's esophagus (BE) surveillance with random biopsies is time-consuming, invasive, and can lead to sampling error. Acetic acid chromoendoscopy (AAC) with targeted biopsies has been proposed as an effective alternative. The aim of this study was to assess the diagnostic accuracy of AAC for the detection of early neoplasia (high-grade dysplasia [HGD] or early cancer [EC]) and specialized intestinal metaplasia (SIM) in patients with BE.

METHODS:

We performed a meta-analysis of all primary studies that compared AAC-based diagnoses (index test) with histopathology as the reference standard. The data were extracted on a per-patient, per-area, and per-procedure basis whenever available.

RESULTS:

Thirteen prospective studies met the inclusion criteria. For the diagnosis of HGD/EC, the pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for all included studies (9 studies, 1379 patients) were 0.92 (95% confidence interval [CI], 0.83-0.97), 0.96 (95% CI, 0.85-0.99), 25.0 (95% CI, 5.9-105.3), and 0.08 (95% CI, 0.04-0.18), respectively. Results were not significantly different when considering only studies with a per-patient analysis. For the characterization of SIM, the pooled sensitivity, specificity, LR+, and LR- for all the included studies (8 studies, 516 patients) were 0.96 (95% CI, 0.83-0.99), 0.69 (95% CI, 0.54-0.81), 3.0 (95% CI, 2.0-4.7), and 0.06 (95% CI, 0.01-0.26), respectively. No significant sources of heterogeneity were identified on subgroup analysis.

CONCLUSION:

AAC has an overall high diagnostic accuracy for detecting HGD/EC in patients with BE. For SIM characterization, AAC sensitivity is very high but has poor specificity, suggesting that histological confirmation is necessary when AAC is positive.

 
Question posée
 
Mise à jour des données concernant l’acide acétique.
 
Question posée
 
Il s ‘agit d’une méta-analyse portant sur 13 études et regroupant un très grand nombre de patients. L’ajout d’acide acétique est une mesure très efficace pour détecter les zones de dysplasie de haut grade (sensibilité 92%, spécificité 96%) au sein d’un EBO.
 
Commentaires

Ces nouvelles données confirment le regain d’intérêt pour l’acide acétique, qui constitue une aide importante pour cibler les biopsies au cours de la surveillance des EBO mais reste globalement sous-utilisé en France.

 
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