Document Detail

Randomized crossover study that used methylene blue or random 4-quadrant biopsy for the diagnosis of dysplasia in Barrett's esophagus.
MedLine Citation:
PMID:  16860068     Owner:  NLM     Status:  MEDLINE    
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.
Chee H Lim; Olorunda Rotimi; Simon P L Dexter; Anthony T R Axon
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  64     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-24     Completed Date:  2006-11-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  195-9     Citation Subset:  IM    
Department of Gastroenterology, Good Hope Hospital, Sutton Coldfield, UK.
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MeSH Terms
Barrett Esophagus / pathology*
Biopsy / methods
Coloring Agents / diagnostic use*
Cross-Over Studies
Image Enhancement
Methylene Blue / diagnostic use
Middle Aged
Mucous Membrane / pathology
Prospective Studies
Sensitivity and Specificity
Reg. No./Substance:
0/Coloring Agents; 61-73-4/Methylene Blue
Comment In:
Gastrointest Endosc. 2006 Aug;64(2):200-5   [PMID:  16860069 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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