Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.

BACKGROUND The diagnostic advantage of methylene blue (MB) chromoendoscopy in Barrett's esophagus is unclear. METHODS Patients with columnar-lined esophagus (CLE) were enrolled into a prospective, randomized crossover trial of MB-directed biopsy versus conventional biopsy. RESULTS Forty-seven patients (19 long-segment CLE; 28 short-segment CLE) were enrolled and underwent MB-directed biopsy. Sensitivity and specificity of MB for specialized intestinal metaplasia were 53% and 51%, respectively. Sensitivity and specificity of MB for dysplasia were 51% and 48%, respectively. Thirty-five patients (15 long-segment CLE; 20 short-segment CLE) completed the crossover trial. Relative frequencies for specialized intestinal metaplasia were 73% and 71% from MB-directed and conventional biopsy specimens, respectively (p = 0.73). Relative frequencies for dysplasia were 20% and 18% from MB-directed and conventional biopsy specimens, respectively (p = 0.65). In patients with long-segment CLE, dysplasia was diagnosed in 10 patients with MB and 7 patients with conventional biopsy methods (p = 0.25). The number of biopsy specimens per EGD was greater with MB, which may have influenced the diagnosis. Histologically, the grade of dysplasia was indefinite/low in nearly all of the dysplastic specimens. CONCLUSIONS Results of MB-directed biopsy were similar to conventional biopsy in detecting specialized intestinal metaplasia and indefinite/low-grade dysplasia. MB was not useful in short-segment Barrett's esophagus.

[1]  N. Powe,et al.  Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus. , 2000, Gastrointestinal endoscopy.

[2]  H. Breyer,et al.  ⁎3521 METHYLENE BLUE CAN DISCLOSE INTESTINAL METAPLASIA IN BARRETT'S ESOPHAGUS? , 2000 .

[3]  L. Gossner,et al.  3537 Chromoendoscopy for the detection of dysplasia or mucosal cancer in barrett`s esophagus. , 2000 .

[4]  M. Mayo,et al.  Increased detection of patients with short segment Barrett's esophagus (SSBE) using chromoendoscopy , 2000 .

[5]  D. Castell,et al.  Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease , 1999, American Journal of Gastroenterology.

[6]  A. Bhattacharyya,et al.  Methylene blue staining for intestinal metaplasia of the gastric cardia with follow-up for dysplasia. , 1998, Gastrointestinal endoscopy.

[7]  R. Sampliner,et al.  Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus , 1998, American Journal of Gastroenterology.

[8]  M. Sivak,et al.  Methylene blue selectively stains intestinal metaplasia in Barrett's esophagus. , 1996, Gastrointestinal endoscopy.

[9]  R. Sampliner,et al.  Diagnostic inconsistencies in Barrett's esophagus , 1994 .

[10]  R. Haggitt,et al.  Barrett's esophagus, dysplasia, and adenocarcinoma. , 1994, Human pathology.

[11]  J B Wong,et al.  A guide for surveillance of patients with Barrett's esophagus. , 1994, The American journal of gastroenterology.

[12]  D. Machin,et al.  Medical Statistics: A Commonsense Approach , 1993 .

[13]  Daniel L. McGee,et al.  Intestinal metaplasia of the stomach: identification by a selective mucosal staining technique. , 1992, Gastrointestinal endoscopy.

[14]  J. Fraumeni,et al.  Rising incidence of adenocarcinoma of the esophagus and gastric cardia. , 1991, JAMA.

[15]  D J Ballard,et al.  Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings. , 1990, Gastroenterology.

[16]  G Van Belle,et al.  Observer variation in the diagnosis of dysplasia in Barrett's esophagus. , 1988, Human pathology.

[17]  M. Tatsuta,et al.  Diagnosis of Minute Cancers by the Endoscopic Congo Red - Methylene Blue Test , 1983, Endoscopy.

[18]  M. Tatsuta,et al.  Endoscopic diagnosis of early gastric cancer by the endoscopic congo red‐methylene blue test , 1982, Cancer.