Crystal violet chromoendoscopy with mucosal pit pattern diagnosis is useful for surveillance of short-segment Barrett's esophagus.
BACKGROUND
Because of a rapid increase in the incidence of Barrett's cancer, the appropriate surveillance method for Barrett's esophagus is of interest. Methylene blue chromoendoscopy has been reported to be an effective and inexpensive method to improve biopsy surveillance of Barrett's epithelium. However, the usefulness of this method in short-segment Barrett's esophagus cases is still controversial.


OBJECTIVE
This study was undertaken to evaluate the abilities of crystal violet and methylene blue chromoendoscopy to detect potentially dysplastic Barrett's epithelium in cases with short-segment columnar-appearing epithelium of the esophago-gastric junction.


METHODS
Four hundred patients with endoscopically suspected short-segment Barrett's esophagus were enrolled and randomly assigned to receive chromoendoscopy with 0.05% crystal violet, 0.1% crystal violet, 0.5% methylene blue, or 1.0% methylene blue. During crystal violet and methylene blue chromoendoscopy, biopsy specimens were obtained from stained and unstained columnar-appearing epithelium of the esophago-gastric junction, and the detection rates of Barrett's epithelium were evaluated. The value of pit pattern diagnosis was also evaluated as a possible way to detect dysplastic Barrett's epithelium.


RESULTS
Chromoendoscopy with 0.05% crystal violet detected histologically confirmed Barrett's epithelium with the highest sensitivity (89.2%) and specificity (85.7%). Crystal violet clearly stained both dysplastic and nondysplastic Barrett's epithelia and made the surface pit pattern easy to observe without using magnifying endoscopy.


CONCLUSIONS
The combination of crystal violet chromoendoscopy and pit pattern diagnosis is considered to be useful for the surveillance of short-segment Barrett's esophagus.
Amano
Yuji
Y
Department of Gastrointestinal Endoscopy, Shimane University, School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan.
Kushiyama
Yoshinori
Y
Ishihara
Shunji
S
Yuki
Takafumi
T
Miyaoka
Youichi
Y
Yoshino
Nagisa
N
Ishimura
Norihisa
N
Fujishiro
Hirofumi
H
Adachi
Kyoichi
K
Maruyama
Riruke
R
Rumi
Mohammad Azharul Karim
MA
Kinoshita
Yoshikazu
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D004396:Coloring Agents; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005840:Gentian Violet; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008751:Methylene Blue; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D012680:Sensitivity and Specificity
D004396:Coloring Agents; D005840:Gentian Violet; D008751:Methylene Blue