Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy

Background: Instillation of acetic acid onto the uterine cervix at colposcopy has been used fear many years to highlight dysplastic areas and 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 was sprayed onto the distal esophagus using a spray catheter, followed immediately by spraying 50 mt of tap water. Results: Initially, a whitish coloration developed in both esophageal and gastric epithelia. After 2 to 3 minutes, the esophageal squamous mucosa remained white but the columnar epithelium became reddish. Remnant islands of Barrett's epithelium were outlined by a white rim. Conclusion: Acetic acid instillation 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.