Original Contribution
The American Journal of Gastroenterology (2005) 100, 21–26; doi:10.1111/j.1572-0241.2005.40028.x
Crystal Violet Chromoendoscopy with Mucosal Pit Pattern Diagnosis is Useful for Surveillance of Short-Segment Barrett's Esophagus
Yuji Amano MD, Yoshinori Kushiyama MD, Shunji Ishihara MD, Takafumi Yuki MD, Youichi Miyaoka MD, Nagisa Yoshino MD, Norihisa Ishimura MD, Hirofumi Fujishiro MD, Kyoichi Adachi MD, Riruke Maruyama MD, Mohammad Azharul Karim Rumi MD and Yoshikazu Kinoshita MD
Department of Gastrointestinal Endoscopy; Department of Gastroenterology and Hepatology; and Department of Clinical Pathology, Shimane University, School of Medicine, Izumo, Japan
Correspondence: Yuji Amano, MD, Department of Gastrointestinal Endoscopy, Shimane University, School of Medicine, 89-1, Enya-cho, Izumo-shi, Shimane 693-8501, Japan.
Received 30 July 2004; Accepted 17 August 2004.
Abstract
BACKGROUND:
Because of a rapid increase in the incidence of Barrett's cancer, the appropriate surveillance method for Barrett's esophagus is of interest. Methylene blue chromoendoscopy has been reported to be an effective and inexpensive method to improve biopsy surveillance of Barrett's epithelium. However, the usefulness of this method in short-segment Barrett's esophagus cases is still controversial.
AIMS:
This study was undertaken to evaluate the abilities of crystal violet and methylene blue chromoendoscopy to detect potentially dysplastic Barrett's epithelium in cases with short-segment columnar-appearing epithelium of the esophago-gastric junction.
PATIENTS AND METHODS:
Four hundred patients with endoscopically suspected short-segment Barrett's esophagus were enrolled and randomly assigned to receive chromoendoscopy with 0.05% crystal violet, 0.1% crystal violet, 0.5% methylene blue, or 1.0% methylene blue. During crystal violet and methylene blue chromoendoscopy, biopsy specimens were obtained from stained and unstained columnar-appearing epithelium of the esophago-gastric junction, and the detection rates of Barrett's epithelium were evaluated. The value of pit pattern diagnosis was also evaluated as a possible way to detect dysplastic Barrett's epithelium.
RESULTS:
Chromoendoscopy with 0.05% crystal violet detected histologically confirmed Barrett's epithelium with the highest sensitivity (89.2%) and specificity (85.7%). Crystal violet clearly stained both dysplastic and nondysplastic Barrett's epithelia and made the surface pit pattern easy to observe without using magnifying endoscopy.
CONCLUSIONS:
The combination of crystal violet chromoendoscopy and pit pattern diagnosis is considered to be useful for the surveillance of short-segment Barrett's esophagus.
