Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2024; 16(5): 259-272
Published online May 16, 2024. doi: 10.4253/wjge.v16.i5.259
Effect of vinegar supplementation on patients with esophageal lesions lightly stained with Lugol’s iodine solution: Prospective single-centre trial
Yuan Gao, Lian-Song Ye, Xu Li, Bin Yu, Ke Liao, Jia Xie, Jiang Du, Qiong-Ying Zhang, Bing Hu
Yuan Gao, Lian-Song Ye, Jia Xie, Jiang Du, Qiong-Ying Zhang, Bing Hu, Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
Xu Li, Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Bin Yu, Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu 610065, Sichuan Province, China
Bin Yu, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610044, Sichuan Province, China
Ke Liao, Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Author contributions: Ye LS and Hu B designed the research; Gao Y, Ke Liao, Xie J, Du J and Zhang QY performed the research and collected the data; Gao Y and Li X analyzed the data and drafted the manuscript; Ye LS, Zhang QY, and Hu B revised the manuscript; All authors performed acquisition of data, contributed to the article, and approved the submitted manuscript.
Supported by the 1-3-5 Project for Disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University, No. 2020HXFH016; and the Med-X Innovation Programme of Med-X Center for Materials, Sichuan University, No. MCM202302.
Institutional review board statement: The study protocol was approved by the Biomedical Research Ethics Committee, West China Hospital of Sichuan University (No. HX-IRB-AF-03-V3.0).
Clinical trial registration statement: This registration policy applies to prospective, controlled trials. The protocol was registered at https://www.chictr.org.cn/showproj.html?proj%20=%204134, registration identifier: ChiCTR1900024686.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: Randomization was not performed in this study, so the manuscript was prepared and revised according to the TREND (transparent reporting of evaluations with nonrandomized designs) statement. The TREND statement has a 22-item checklist Cdc-pdf specifically developed to guide standardized reporting of nonrandomized controlled trials. The TREND statement complements the widely adopted Consolidated Standards Of Reporting Trials (CONSORT) statement developed for randomized controlled trials.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bing Hu, MD, Professor, Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. hubing@wchscu.edu.cn
Received: February 5, 2024
Revised: March 12, 2024
Accepted: April 22, 2024
Published online: May 16, 2024
Processing time: 98 Days and 23.6 Hours
Abstract
BACKGROUND

Esophageal chromoendoscopy with iodine solution is important for detecting early esophageal cancer. The effect of routine treatment for lesions lightly stained with Lugol’s iodine solution is limited, and the addition of natural substances to a regular diet is becoming increasingly common. Vinegar has antitumor effects as reported in previous studies.

AIM

To evaluate whether vinegar supplementation could improve the prognosis of patients with lightly stained esophageal lesions.

METHODS

This prospective single-centre trial included consecutive patients with lightly stained lesions between June 2020 and April 2022. Patients in the experimental group received increased amounts of vinegar for 6 months. The primary outcome of the study was the clinical therapeutic effect. Complications related to vinegar ingestion and adverse events were also recorded in detail.

RESULTS

A total of 166 patients were included in the final analysis. There was no significant difference in the baseline data between the two groups. Intention-to-treat (ITT) analysis demonstrated that the rates at which endoscopic characteristics improved were 33.72% in the experimental group and 20.00% in the conventional group (P = 0.007); and the rates at which biopsy pathology improved were 19.77% and 8.75%, respectively (P = 0.011). Additional vinegar consumption had a statistically protective effect on the rate at which endoscopic characteristics improved [hazard ratio (HR) ITT = 2.183, 95%CI: 1.183-4.028; HRper-protocol (PP) = 2.307, 95%CI: 1.202-4.426] and biopsy pathology improved (HRITT = 2.931, 95%CI: 1.212-7.089; HRPP = 3.320, 95%CI: 1.295-8.507). No statistically significant effect of increased vinegar consumption on preventing high-grade intraepithelial neoplasia or early cancer was observed (HRITT = 0.382, 95%CI: 0.079-1.846; HRPP = 0.382, 95%CI: 0.079-1.846). The subgroup analyses indicated that the overall therapeutic improvement of endoscopic characteristics and biopsy pathology seemed more obvious in older (age > 60) male patients with small lesions (lesion size ≤ 0.5 cm). Three patients in the experimental group reported acid regurgitation and heartburn. No adverse event during gastroscopy were recorded during follow-up.

CONCLUSION

A moderately increased ingestion of vinegar could not directly reduce the risk of esophageal cancer in the mucosa dysplasia population, but it improved the endoscopic characteristics and ameliorated the biopsy pathology to a certain extent. Further research is needed to verify the effect of nutritional intervention on precancerous esophageal lesions.

Keywords: Chromoendoscopy; Esophageal squamous epithelium; Vinegar; Atypical hyperplasia; Prognosis

Core Tip: Esophageal lesions stained lightly with iodine solution may progress pathologically even though they have a relatively better prognosis. Vinegar was thought to have an antitumor effect according to previous studies. However, its effect on lesion progression is still unclear. In the present study, we reported that moderate vinegar consumption improved the prognosis of several esophageal lesions lightly stained with Lugol’s iodine solution at a tertiary referral endoscopy centre in China.