title: Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.
abstract: 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.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Anatomic Pathology, University of Louisville School of Medicine and VA Medical Center, Louisville, Kentucky, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Wo
authors.forename: M B
authors.initials: MB
authors.lastname: Ray
authors.forename: S
authors.initials: S
authors.lastname: Mayfield-Stokes
authors.forename: G
authors.initials: G
authors.lastname: Al-Sabbagh
authors.forename: F
authors.initials: F
authors.lastname: Gebrail
authors.forename: S P
authors.initials: SP
authors.lastname: Slone
authors.forename: M A
authors.initials: MA
authors.lastname: Wilson
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D018592:Cross-Over Studies; D016145:Endoscopy, Digestive System; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
chemical_list: D008751:Methylene Blue