title: Endocytoscopic visualization of squamous cell islands within Barrett's epithelium.
abstract: OBJECTIVE
  To study the endocytoscopic visualization of squamous cell islands within Barrett's epithelium.
  
  
  METHODS
  Endocytoscopy (ECS) has been studied in the surveillance of Barrett's esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for the staining of Barrett's mucosa. Integrated type endocytoscopes (GIF-Q260 EC, Olympus Corp, Tokyo, Japan) have been recently developed, with the incorporation of a high-power magnifying endocytoscope into a standard endoscope together with narrow-band imaging (NBI). Moreover, double staining with a mixture of 0.05% crystal violet and 0.1% of methylene blue (CM) during ECS enables higher quality images comparable to conventional hematoxylin eosin histopathological images.
  
  
  RESULTS
  In vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett's epithelium in a patient with long-segment Barrett's esophagus is reported. Conventional white light endoscopy showed typical long-segment Barrett's esophagus, with small squamous cell islands within normal Barrett's mucosa, which were better visualized by NBI endoscopy. ECS after double CM staining showed regular Barrett's esophagus, while higher magnification (× 480) revealed the orifices of glandular structures better. Furthermore, typical squamous cell papillary protrusion, classified as endocytoscopic atypia classification (ECA) 2 according to ECA, was identified within regular glandular Barrett's mucosa. Histological examination of biopsies taken from the same area showed squamous epithelium within glandular Barrett's mucosa, corresponding well to endocytoscopic findings.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of in vivo visualization of esophageal papillary squamous cell islands surrounded by glandular Barrett's epithelium.
authors.affiliation: Nicholas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Toshihisa Hosoya, Roberta Maselli, Shin-ei Kudo, Digestive Disease Center, Showa University, Northern Yokohama Hospital, Tsuzuki-ku, Yokohama 224-8503, Japan.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Eleftheriadis
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.forename: Manabu
authors.initials: M
authors.lastname: Onimaru
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Hosoya
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
keywords: Barrett’s esophagus; Crystal violet; Endocytoscopic atypia classification; Endocytoscopy; Hematoxylin eosin stain; Methylene blue; Surveillance