TY - JOUR
T1 - Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus
AU - Canto, Marcia Irene F.
AU - Setrakian, Sebouh
AU - Willis, Joseph
AU - Chak, Amitabh
AU - Petras, Robert
AU - Powe, Neil R.
AU - Sivak, Michael V.
N1 - Funding Information:
Supported in part by the ASGE-Olympus Advanced Therapeutic Endoscopy Scholarship.
PY - 2000
Y1 - 2000
N2 - Background: Endoscopically applied methylene blue selectively stains specialized columnar epithelium in Barrett's esophagus. Methods: The diagnostic yield and cost of cancer surveillance in patients with Barrett's esophagus using methylene blue-directed biopsies (MBDB) were compared with surveillance using a 'jumbo' random biopsy technique in a prospective, sequential, controlled trial. Esophagogastroduodenoscopy was performed with either MBDB or random biopsy in a randomized sequence. The proportions of various types of epithelia in each biopsy were estimated and dysplasia was graded in a blinded fashion. Results: Forty-three patients with short- (n = 8), limited- (n = 10), and long-segment (n = 25) Barrett's esophagus were studied. Using MBDB technique, the average number of biopsies obtained per patient was significantly lower and the proportion of specialized columnar epithelium in each specimen was significantly higher compared with random biopsy. Dysplasia or cancer was diagnosed in significantly more MBDB specimens (12% vs. 6%, p = 0.004). Despite fewer biopsies per patient using MBDB, dysplasia or cancer was diagnosed in significantly more patients (44% vs. 28%, p = 0.03) than by random biopsy technique. MBDB cost less and detected more cancers than random biopsy. Conclusions: MBDB is a more accurate and cost-effective technique than random biopsy for diagnosing specialized columnar epithelium and dysplasia/cancer, particularly in long- segment Barrett's esophagus.
AB - Background: Endoscopically applied methylene blue selectively stains specialized columnar epithelium in Barrett's esophagus. Methods: The diagnostic yield and cost of cancer surveillance in patients with Barrett's esophagus using methylene blue-directed biopsies (MBDB) were compared with surveillance using a 'jumbo' random biopsy technique in a prospective, sequential, controlled trial. Esophagogastroduodenoscopy was performed with either MBDB or random biopsy in a randomized sequence. The proportions of various types of epithelia in each biopsy were estimated and dysplasia was graded in a blinded fashion. Results: Forty-three patients with short- (n = 8), limited- (n = 10), and long-segment (n = 25) Barrett's esophagus were studied. Using MBDB technique, the average number of biopsies obtained per patient was significantly lower and the proportion of specialized columnar epithelium in each specimen was significantly higher compared with random biopsy. Dysplasia or cancer was diagnosed in significantly more MBDB specimens (12% vs. 6%, p = 0.004). Despite fewer biopsies per patient using MBDB, dysplasia or cancer was diagnosed in significantly more patients (44% vs. 28%, p = 0.03) than by random biopsy technique. MBDB cost less and detected more cancers than random biopsy. Conclusions: MBDB is a more accurate and cost-effective technique than random biopsy for diagnosing specialized columnar epithelium and dysplasia/cancer, particularly in long- segment Barrett's esophagus.
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U2 - 10.1016/S0016-5107(00)70290-2
DO - 10.1016/S0016-5107(00)70290-2
M3 - Article
C2 - 10805842
AN - SCOPUS:0034105209
SN - 0016-5107
VL - 51
SP - 560
EP - 568
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -