A Randomized Comparison of Methylene Blue-Directed Biopsy... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTION: ESOPHAGUS

A Randomized Comparison of Methylene Blue-Directed Biopsy Versus Conventional Four-Quadrant Biopsy for the Detection of Intestinal Metaplasia and Dysplasia in Patients With Long-Segment Barrett's Esophagus

Horwhat, John David M.D.; Maydonovitch, Corinne L. B.S.; Ramos, Fernando M.D.; Colina, Ramon M.D.; Gaertner, Erich M.D.; Lee, Hyun B.A.; Wong, Roy K.H. M.D.

Walter Reed Army Medical Center, Gastroenterology Service, Department of Medicine, Washington, District of Columbia; and Uniformed Service University of the Health Sciences, Bethesda, Maryland

Reprint requests and correspondence: Dr. Roy K.H. Wong, M.D., 7F, 6900 Georgia Avenue, NW, Washington, DC 20307.

The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government.

CONFLICT OF INTEREST

Guarantor of the article: J. David Horwhat, M.D.

Specific author contributions: J. David Horwhat: performed study examinations, data collection and input, data analysis, and manuscript preparation, and edited manuscript; Corinne Maydonovitch: study design, statistical analysis, data analysis, editing of manuscript; Fernando Ramos: study design, performing study exams; Ramon Colina: study design, performing study exams; Erich Gaertner: pathologist; Hyun Lee: data collection, data input; Roy Wong: study design, data analysis, manuscript preparation, and editing (senior investigator).

Financial support: None.

Potential competing interests: None.

Received March 13, 2007; accepted August 31, 2007.

Abstract

OBJECTIVES

Methylene blue (MB) selectively stains specialized intestinal metaplasia (SIM) and may assist in surveying a columnar-lined esophagus for Barrett's esophagus associated dysplasia.

METHODS

This is a prospective, randomized crossover study comparing 4-quadrant random biopsies (4QB) versus MB-directed biopsies for the detection of SIM and dysplasia in 48 patients with long segment Barrett's esophagus (LSBE). Patients randomly underwent two endoscopies over a 4-wk time period with either 4QB or MB-directed biopsies as their first or second exam. Our aim was to correlate stain intensity with histology.

RESULTS

The sensitivity of MB for SIM and dysplasia was 75.2% and 83.1%, respectively. The yield of 4QB for identifying nondysplasia SIM was 57.6% (523/917) and for dysplasia was 12% (111/917). Dark staining was significantly associated with histologic grade (P < 0.007). The final diagnosis was correct in 43 (90%) patients using MB and in 45 (94%) using 4QB. The 4QB technique missed dysplasia in 3 of 21 patients while MB biopsies missed dysplasia in 5 of 21 patients. The discordance between the two techniques was not significant (_P_= 0.727, McNemar's test). The mean number of biopsies taken during 4QB was 18.92 ± 6.36 and with MB was 9.23 ± 2.89 (P < 0.001).

CONCLUSION

MB requires significantly fewer biopsies than 4QB to evaluate for SIM and dysplasia. Dark staining correlates more with HGD than LGD in our experience. While MB is not more accurate than 4QB, MB may help to define areas to target for biopsy during surveillance endoscopy in patients with LSBE.