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.
RCT Entities:
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.
Authors: K K Wang; J M Tian; E Gorospe; J Penfield; G Prasad; T Goddard; M Wongkeesong; N S Buttar; L Lutzke; S Krishnadath Journal: Dis Esophagus Date: 2012-03-12 Impact factor: 3.429
Authors: Stuart J Spechler; Prateek Sharma; Rhonda F Souza; John M Inadomi; Nicholas J Shaheen Journal: Gastroenterology Date: 2011-03 Impact factor: 22.682
Authors: Matthew B Sturm; Bishnu P Joshi; Shaoying Lu; Cyrus Piraka; Supang Khondee; Badih Joseph Elmunzer; Richard S Kwon; David G Beer; Henry D Appelman; Danielle Kim Turgeon; Thomas D Wang Journal: Sci Transl Med Date: 2013-05-08 Impact factor: 17.956
Authors: Prateek Sharma; Alexander R Meining; Emmanuel Coron; Charles J Lightdale; Herbert C Wolfsen; Ajay Bansal; Monther Bajbouj; Jean-Paul Galmiche; Julian A Abrams; Amit Rastogi; Neil Gupta; Joel E Michalek; Gregory Y Lauwers; Michael B Wallace Journal: Gastrointest Endosc Date: 2011-07-13 Impact factor: 9.427
Authors: Kenneth K Wang; Ngozi Okoro; Ganapathy Prasad; Michel WongKeeSong; Navtej S Buttar; Jianmin Tian Journal: Gastrointest Endosc Clin N Am Date: 2011-01