Kouklakis G S, Kountouras J, Dokas S M, Molyvas E J, Vourvoulakis G P, Minopoulos G I
Dept. of Gastroenterology, 424 General Military Hospital, Thessaloniki, Greece.
Endoscopy. 2003 May;35(5):383-7. doi: 10.1055/s-2003-38768.
Specialized columnar epithelium of Barrett's esophagus is a precursor of dysplasia and adenocarcinoma, and methylene blue selectively stains this type of epithelium. The present prospective study examined the detection of short-segment and long-segment Barrett's esophagus using methylene blue chromoendoscopy-directed biopsies, in comparison with biopsies directed using conventional endoscopic criteria.
Biopsies were obtained from macroscopically conspicous areas in the distal esophagus observed during conventional endoscopy in a total of 975 patients. Immediately after conventional biopsies, the distal esophagus was sprayed with methylene blue and directed biopsies were then obtained from the stained regions. All patients with a histologically established Barrett's esophagus underwent a second upper gastrointestinal endoscopy within 1 year in order to assess the reproducibility of the method.
In a total of 3,900 conventional biopsy specimens (without staining), 54 specimens (1.4%) were found to show Barrett's esophagus and were confined to 16 of the 975 patients (1.6%). Of the total 130 directed biopsy specimens obtained during chromoendoscopy, 114 (87.7%) revealed Barrett's esophagus (P<0.00001) and were confined to 35 of the 975 patients (3.5%; P < or = 0.001). The findings were confirmed within 1 year in all dye-positive patients.
Chromoendoscopy with methylene blue appears to be an accurate, simple, safe, inexpensive, and reproducible method of detecting specialized columnar epithelium in Barrett's esophagus.
巴雷特食管的特殊柱状上皮是发育异常和腺癌的前体，亚甲蓝可选择性地对这类上皮进行染色。本前瞻性研究通过亚甲蓝染色内镜引导活检来检测短段和长段巴雷特食管，并与采用传统内镜标准引导的活检进行比较。
对975例患者进行传统内镜检查时，从食管远端肉眼可见的区域获取活检样本。在传统活检后，立即向食管远端喷洒亚甲蓝，然后从染色区域获取定向活检样本。所有组织学确诊为巴雷特食管的患者在1年内接受了第二次上消化道内镜检查，以评估该方法的可重复性。
在总共3900份传统活检样本（未染色）中，发现54份样本（1.4%）显示为巴雷特食管，且仅限于975例患者中的16例（1.6%）。在染色内镜检查期间获取的总共130份定向活检样本中，114份（87.7%）显示为巴雷特食管（P<0.00001），且仅限于975例患者中的35例（3.5%；P≤0.001）。所有染料阳性患者在1年内均得到了证实。
亚甲蓝染色内镜似乎是一种准确、简单、安全、廉价且可重复的检测巴雷特食管特殊柱状上皮的方法。
