Hey #GITwitter! Here is a case of a pt w/ long segment Barrett’s referred for indefinite dysplasia. This video demonstrates why you should use acetic acid on all Barrett's pts. It's a cost-effective, evidence-based tool accessible to all, that will help you detect HGD+.

You put in syringe and spray through scope? You dilute with normal saline? What are your references for its use?

Yes. I just put in 60cc slip top syringe and spray through channel. I do not dilute, it comes from pharmacy compounded at 2.5%. Evidence is for 1.5-2.5%. See ASGE document for summary of the sens/spec/NPV.

@DavidDiehlMD is an acetic acid enthusiastic as well.

Very cool! So much more obvious than with WL/NBI only

Yes! Also, LCI will further exaggerate the contrast you see from the premature loss of acetowhitening reaction

Excellent demonstration on the use of acetic acid! Thank you! #MedEd #Barrettsesophagus

Thank you!

Beautiful demonstration. Love using acetic acid

Thanks Ali!

Do you use any other dyes in the esophagus in your practice? For example the Lugol solution? A yellow/brownish color. Thanks.

Yes I do. But not for Barrett's. Lugol's I use for patients with or at high risk of squamous neoplasia.