Methylene blue chromoendoscopy for detection of short-segment Barrett's esophagus

• Published in: Gastrointestinal endoscopy Vol. 54; no. 3; pp. 289 - 293
• Main Authors: Sharma, Prateek, Topalovski, Margarita, Mayo, Matthew S., Weston, Allan P.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2001; Elsevier
• Subjects: Barrett Esophagus - pathology; Biological and medical sciences; Biopsy - methods; Case-Control Studies; Digestive system. Abdomen; Endoscopy; Endoscopy, Digestive System; Esophagus - pathology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Methylene Blue; Middle Aged; Staining and Labeling; Human; Esophageal disease; Barrett esophagus; Methylene blue; Association; Biopsy; Length; Intestinal metaplasia; Digestive diseases; Intestinal disease; Diagnosis; Endoscopy; Technique; Comparative study
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2001.115728

Background: The yield of intestinal metaplasia (IM) with randomly obtained biopsy specimens in patients with short lengths of columnar-appearing mucosa in the distal esophagus is low (30%-50%). Vital staining would be beneficial if it identified more patients with short-segment Barrett's esophagus (SSBE). Our aim was to compare the confirmation of IM in patients with suspected SSBE (columnar-appearing mucosa <3 cm in length) by using methylene blue (MB)-directed versus random biopsies. Methods: Consecutive patients undergoing EGD in whom columnar-appearing mucosa less than 3 cm in length was visualized underwent MB staining. Stained areas within suspected SSBE segments were targeted for biopsies. All biopsy specimens were stained with H & E with alcian blue at pH 2.5 and evaluated by a single pathologist. A historical control group (different from patients undergoing MB staining) consisted of patients with less than 3 cm of columnar-appearing mucosa in whom biopsy specimens were obtained randomly without MB staining. Results: The MB group included 75 patients (mean age 63.8 ± 10.9 years) with a mean length of columnar-appearing mucosa of 1.2 cm (range 0.5-2.5 cm). The control group included 83 patients (mean age 60.5 ± 12.9 years) with a mean length of columnar-appearing mucosa of 1.16 cm (range 0.5-2.5 cm). IM (i.e., confirmed SSBE) was detected in 61% of the MB group versus 42% of the control group ( p = 0.0237). Patients in the MB group required significantly fewer biopsies (4.3 ± 1.5 vs. 5.1 ± 12.3, p = 0.0162). Confirmation of IM by length was as follows: less than 1 cm (irregular Z line), MB 17.4% versus control 25% ( p = 0.73); 1 to less than 2 cm, MB 77% versus control 45% ( p = 0.03); 2 to less than 3 cm, MB 90% versus control 58% ( p = 0.02). Conclusions: MB chromoendoscopy significantly increases the detection of IM and requires fewer biopsies in patients with suspected SSBE with greater than 1 cm of columnar-appearing mucosa. It does not appear to be beneficial in patients with irregular Z lines (<1 cm). (Gastrointest Endosc 2001;54:289-93.)