Endoscopic biopsy techniques in Barrett esophagus patients: a multidesign study

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.