亚甲蓝染色内镜检查用于检测短节段巴雷特食管。

Methylene blue chromoendoscopy for detection of short-segment Barrett's esophagus.

作者信息

Sharma P, Topalovski M, Mayo M S, Weston A P

机构信息

Division of Gastroenterology, Department of Pathology and Preventive Medicine, University of Kansas and Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.

出版信息

Gastrointest Endosc. 2001 Sep;54(3):289-93. doi: 10.1067/mge.2001.115728.

DOI:10.1067/mge.2001.115728

PMID:11522967

Abstract

BACKGROUND

The yield of intestinal metaplasia (IM) with randomly obtained biopsy specimens in patients with short lengths of columnar-appearing mucosa in the distal esophagus is low (30%-50%). Vital staining would be beneficial if it identified more patients with short-segment Barrett's esophagus (SSBE). Our aim was to compare the confirmation of IM in patients with suspected SSBE (columnar-appearing mucosa <3 cm in length) by using methylene blue (MB)-directed versus random biopsies.

METHODS

Consecutive patients undergoing EGD in whom columnar-appearing mucosa less than 3 cm in length was visualized underwent MB staining. Stained areas within suspected SSBE segments were targeted for biopsies. All biopsy specimens were stained with H & E with alcian blue at pH 2.5 and evaluated by a single pathologist. A historical control group (different from patients undergoing MB staining) consisted of patients with less than 3 cm of columnar-appearing mucosa in whom biopsy specimens were obtained randomly without MB staining.

RESULTS

The MB group included 75 patients (mean age 63.8 +/- 10.9 years) with a mean length of columnar-appearing mucosa of 1.2 cm (range 0.5-2.5 cm). The control group included 83 patients (mean age 60.5 +/- 12.9 years) with a mean length of columnar-appearing mucosa of 1.16 cm (range 0.5-2.5 cm). IM (i.e., confirmed SSBE) was detected in 61% of the MB group versus 42% of the control group (p = 0.0237). Patients in the MB group required significantly fewer biopsies (4.3 +/- 1.5 vs. 5.1 +/- 12.3, p = 0.0162). Confirmation of IM by length was as follows: less than 1 cm (irregular Z line), MB 17.4% versus control 25% (p = 0.73); 1 to less than 2 cm, MB 77% versus control 45% (p = 0.03); 2 to less than 3 cm, MB 90% versus control 58% (p = 0.02).

CONCLUSIONS

MB chromoendoscopy significantly increases the detection of IM and requires fewer biopsies in patients with suspected SSBE with greater than 1 cm of columnar-appearing mucosa. It does not appear to be beneficial in patients with irregular Z lines (<1 cm).

摘要

背景

在远端食管柱状黏膜长度较短的患者中，随机获取活检标本时肠化生（IM）的检出率较低（30%-50%）。如果能识别出更多短节段巴雷特食管（SSBE）患者，活体染色将很有帮助。我们的目的是比较使用亚甲蓝（MB）引导活检与随机活检对疑似SSBE（柱状黏膜长度<3 cm）患者IM的确诊情况。

方法

连续接受上消化道内镜检查（EGD）且可见长度小于3 cm的柱状黏膜的患者接受MB染色。对疑似SSBE节段内的染色区域进行活检。所有活检标本用苏木精-伊红（H&E）染色，并在pH 2.5条件下用阿尔辛蓝染色，由一名病理学家进行评估。一个历史对照组（与接受MB染色的患者不同）由柱状黏膜长度小于3 cm且未进行MB染色随机获取活检标本的患者组成。

结果

MB组包括75例患者（平均年龄63.8±10.9岁），柱状黏膜平均长度为1.2 cm（范围0.5-2.5 cm）。对照组包括83例患者（平均年龄60.5±12.9岁），柱状黏膜平均长度为1.16 cm（范围0.5-2.5 cm）。MB组中IM（即确诊的SSBE）的检出率为61%，而对照组为42%（p = 0.0237）。MB组患者所需的活检次数明显较少（4.3±1.5次对5.1±12.3次，p = 0.0162）。根据长度确诊IM的情况如下：小于1 cm（不规则Z线），MB组为17.4%，对照组为25%（p = 0.73）；1至小于2 cm，MB组为77%，对照组为45%（p = 0.03）；2至小于3 cm，MB组为90%，对照组为58%（p = 0.02）。