Evaluation of modified crystal violet chromoendoscopy procedure using new mucosal pit pattern classification for detection of Barrett's dysplastic lesions.
BACKGROUND
Pit pattern diagnosis is important for endoscopic detection of dysplastic Barrett's lesions, though using magnification endoscopy can be difficult and laborious. We investigated the usefulness of a modified crystal violet chromoendoscopy procedure and utilised a new pit pattern classification for diagnosis of dysplastic Barrett's lesions.


METHODS
A total of 1,030 patients suspected of having a columnar lined oesophagus were examined, of whom 816 demonstrated a crystal violet-stained columnar lined oesophagus. The early group of patients underwent 0.05% crystal violet chromoendoscopy, while the later group was examined using 0.03% crystal violet with 3.0% acetate. A targeted biopsy of the columnar lined oesophagus was performed using crystal violet staining after making a diagnosis of closed or open type pit pattern with a newly proposed system of classification. The relationship between type of pit pattern and histologically identified dysplastic Barrett's lesions was evaluated.


RESULTS
Dysplastic Barrett's lesions were identified in biopsy samples with an open type pit pattern with a sensitivity of 96.0%. Further, Barrett's mucosa with the intestinal predominant mucin phenotype was closely associated with the open type pit pattern (sensitivity 81.9%, specificity 95.6%).


CONCLUSIONS
The new pit pattern classification for diagnosis of Barrett's mucosa was found to be useful for identification of cases with dysplastic lesions and possible malignant potential using a crystal violet chromoendoscopic procedure.
Yuki
T
T
Department of Gastroenterology and Hepatology, Shimane University, School of Medicine, Japan.
Amano
Y
Y
Kushiyama
Y
Y
Takahashi
Y
Y
Ose
T
T
Moriyama
I
I
Fukuhara
H
H
Ishimura
N
N
Koshino
K
K
Furuta
K
K
Ishihara
S
S
Adachi
K
K
Kinoshita
Y
Y
D000085:Acetates; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005840:Gentian Violet; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology
D000085:Acetates; D000891:Anti-Infective Agents, Local; D005840:Gentian Violet