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Randomized Controlled Trial
. 2025 Sep;57(9):962-971.
doi: 10.1055/a-2606-7682. Epub 2025 Jun 24.

Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study

Ilse N Beaufort  1   2 , Sjoerd G Elias  3 , Elisabeth M P Akkerman  1 , Anya N Milne  4 , Lodewijk A A Brosens  5 , Marc A M T Verhagen  6 , Lorenza Alvarez Herrero  2 , Bas L A M Weusten  2   1
Affiliations
Randomized Controlled Trial

Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study

Ilse N Beaufort et al. Endoscopy. 2025 Sep.

Abstract

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

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Conflict of interest statement

B.L.A.M. Weusten is a consultant for Pentax Medical, and has received speaker fees from Pentax Medical and research funding from Aqua Medical and Pentax Medical. I.N. Beaufort, S.G. Elias, E.M.P. Akkerman, A.N. Milne, L.A.A. Brosens, M.A.M.T. Verhagen, and L. Alvarez Herrero declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient flow diagram depicting the randomization process of study Part I (i.e. prospective factorial design trial).
Fig. 2
Fig. 2
Examples of biopsies taken from Barrett esophagus mucosa using different methods and techniques. a,b Single-biopsy method and turn-and-suction technique. c,d Single-biopsy method and advance-and-close technique. e,f Double-biopsy method and turn-and-suction technique. g,h Double-biopsy method and advance-and-close technique.
See this image and copyright information in PMC

References

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