Methylene blue chromoendoscopy for the detection of Barrett's esophagus in a Greek cohort.
OBJECTIVE
Specialized columnar epithelium of Barrett's esophagus is a precursor of dysplasia and adenocarcinoma, and methylene blue selectively stains this type of epithelium. The present prospective study examined the detection of short-segment and long-segment Barrett's esophagus using methylene blue chromoendoscopy-directed biopsies, in comparison with biopsies directed using conventional endoscopic criteria.


METHODS
Biopsies were obtained from macroscopically conspicous areas in the distal esophagus observed during conventional endoscopy in a total of 975 patients. Immediately after conventional biopsies, the distal esophagus was sprayed with methylene blue and directed biopsies were then obtained from the stained regions. All patients with a histologically established Barrett's esophagus underwent a second upper gastrointestinal endoscopy within 1 year in order to assess the reproducibility of the method.


RESULTS
In a total of 3,900 conventional biopsy specimens (without staining), 54 specimens (1.4%) were found to show Barrett's esophagus and were confined to 16 of the 975 patients (1.6%). Of the total 130 directed biopsy specimens obtained during chromoendoscopy, 114 (87.7%) revealed Barrett's esophagus (P<0.00001) and were confined to 35 of the 975 patients (3.5%; P < or = 0.001). The findings were confirmed within 1 year in all dye-positive patients.


CONCLUSIONS
Chromoendoscopy with methylene blue appears to be an accurate, simple, safe, inexpensive, and reproducible method of detecting specialized columnar epithelium in Barrett's esophagus.
Kouklakis
G S
GS
Dept. of Gastroenterology, 424 General Military Hospital, Thessaloniki, Greece. gastro@hol.gr
Kountouras
J
J
Dokas
S M
SM
Molyvas
E J
EJ
Vourvoulakis
G P
GP
Minopoulos
G I
GI
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D001707:Biopsy, Needle; D015331:Cohort Studies; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011336:Probability; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution
D008751:Methylene Blue