Randomized crossover study that used methylene blue or random 4-quadrant biopsy for the diagnosis of dysplasia in Barrett’s esophagus - 16/08/11
Reprint requests: C. H. Lim, MRCP, Department of Gastroenterology, Good Hope Hospital NHS Trust, Rectory Rd, Sutton Coldfield, W Midlands, B75 7RR, UK.Leeds, United Kingdom
Abstract |
Background |
Barrett’s esophagus is generally accepted to be a premalignant condition. Previous studies have suggested the use of methylene blue (MB) chromoendoscopy to aid the identification of dysplasia in Barrett’s esophagus surveillance programs, but a recent study has raised the concern that MB might induce oxidative damage of DNA.
Objective |
The aim of this study was to compare MB directed biopsies (MBDB) with our current standard, which is random 4 quadrant biopsies (RB).
Design |
A randomized prospective crossover study.
Setting |
Single center.
Patients |
Patients with a diagnosis of dysplasia identified in Barrett’s esophagus within a 2-year period before entering the study.
Interventions |
Either 4 random quadrant biopsies taken every 2 cm through the length of the Barrett’s esophagus or MBDB from unstained or heterogenously stained mucosa.
Main Outcome Measurements |
The number of patients with a diagnosis of dysplasia by each intervention.
Limitations |
Thirty-six percent of eligible patients declined the invitation to participate.
Results |
Thirty patients completed the crossover study. The median length of Barrett’s esophagus was 5 cm (interquartile range [IQR] 3-9 cm). At baseline histology, grades were as follows: 17 low-grade dysplasia (LGD), 3 high-grade dysplasia (HGD), and 10 no dysplasia. At completion, there were 10 LGD, 8 HGD, and 12 no dysplasia. Overall, dysplasia was identified in 17 of 18 patients by RB and in 9 of 18 by MBDB (McNemar test, p = 0.02).
Conclusions |
Our study showed MBDB to be significantly less sensitive in detecting dysplasia than RB in Barrett’s esophagus. Hence, we discourage its use during routine surveillance of Barrett’s esophagus.
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Vol 64 - N° 2
P. 195-199 - août 2006 Retour au numéro
Article précédent
- Seeing the light: enhanced endoscopic imaging to glimpse the Holy Grail
- Gregory G. Ginsberg
- Chromoendoscopy for Barrett’s esophagus in the twenty-first century: to stain or not to stain?
- Marcia Irene Canto, Anthony Kalloo
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