Methylene blue chromoendoscopy for detection of short-segment Barrett's esophagus
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 esopha...
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Published in | Gastrointestinal endoscopy Vol. 54; no. 3; pp. 289 - 293 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Mosby, Inc
01.09.2001
Elsevier |
Subjects | |
Online Access | Get full text |
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Summary: | 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.) |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0016-5107 1097-6779 |
DOI: | 10.1067/mge.2001.115728 |