Methylene blue chromoendoscopy for detecting intestinal metaplasia in Barrett‘s esophagus

Dr Mahesh GS; Dr Shanth Kumar PN

Volume : V, Issue : X, October - 2016

Methylene blue chromoendoscopy for detecting intestinal metaplasia in Barrett‘s esophagus

Dr Mahesh Gs, Dr Shanth Kumar Pn

Abstract :

The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett�s oesophagus with the risk of Malignancy in future. The distribution of both IM and dysplasia (low grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is patchy and mosaic requiring random biopsies. Techniques that could help target areas of high yield within Barrett�s mucosa would be helpful. Methods: patients detected with columnar mucosa in the distal oesophagus were studied. The distal oesophagus was sprayed with Methylene blue and the oesophageal columnar mucosa patterns were noted and targeted for biopsy. All biopsies were read by pathologists blinded to the endoscopic findings. Results: Eighty patients with suspected Barrett�s oesophagus (that is, columnar lined distal oesophagus) were studied: mean age 45 years (range 30–60). Mean length of columnar mucosa was 3.7 cm (range 0.5–17). Three types of mucosal patterns were noted within the columnar mucosa after spraying Methylene Blue – villous pattern, circular pattern, and irregular pattern. The yield of IM on target biopsies according to the patterns was: villous 57/62 (97%) and circular 2/12 (17%). Six patients had an irregular pattern and all had high grade dysplasia (HGD) on biopsy (6/6 (100%)). Eighteen patients had Low grade dysplasia (LGD) on target biopsies; all had the villous pattern. All patients with long segment Barrett�s were identified using MCE whereas 23/28 patients (82%) with short segment Barrett�s had the villous pattern. Conclusion : MB helps visually identify areas with IM and HGD having specific patterns but not patients with LGD (appear similar to IM). MB may be a useful clinical tool for the increased detection of patients with IM as well as for surveillance of patients for the detection of HGD. If these preliminary results are validated, MB would help identify high yield areas, potentially eliminating the need for random biopsies.