Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus
Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus
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DOI：
10.1016/s0016-5107(00)70290-2
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发表时间：
2000-05-01
影响因子：
7.7
通讯作者：
Sivak, MV
中科院分区：
文献类型：
--
作者：
Canto, MIF;Setrakian, S;Sivak, MV
背景资料：内镜应用亚甲蓝选择性染色专门的柱状上皮在巴雷特食管，方法：诊断率和成本的巴雷特食管患者使用亚甲蓝定向活检（MBDB）的癌症监测进行了比较，监测使用“巨型”随机活检技术在一个前瞻性的，连续的，对照试验。食管胃镜检查进行MBDB或随机活检在一个随机序列，在每个活检的各种类型的上皮细胞的比例进行了估计和异型增生进行了分级在一个盲fashion.Results：43例患者短（n = 8），有限（n = 10），和长段（n = 25）Barrett食管进行了研究。使用MBDB技术，与随机活检相比，每个患者获得的活检平均数量显著降低，每个标本中特化柱状上皮的比例显著升高。在显著更多的MBDB标本中诊断出异型增生或癌症（12%对6%，p = 0.004）。尽管使用MBDB的每位患者的活检较少，但与随机活检技术相比，在显著更多的患者中诊断出异型增生或癌症（44%对28%，p = 0.03）。MBDB成本更低，发现更多的癌症比随机活检，结论：MBDB是一个更准确和成本效益的技术比随机活检诊断专门的柱状上皮和异型增生/癌症，特别是在长段巴雷特食管。
Background: Endoscopically applied methylene blue selectively stains specialized columnar epithelium in Barrett's esophagus,Methods: The diagnostic yield and cost of cancer surveillance in patients with Barrett's esophagus using methylene blue-directed biopsies (MBDB) were compared with surveillance using a "jumbo" random biopsy technique in a prospective, sequential, controlled trial. Esophagogastroduodenoscopy was performed with either MBDB or random biopsy in a randomized sequence, The proportions of various types of epithelia in each biopsy were estimated and dysplasia was graded in a blinded fashion.Results: Forty-three patients with short- (n = 8), limited- (n = 10), and long-segment (n = 25) Barrett's esophagus were studied. Using MBDB technique, the average number of biopsies obtained per patient was significantly lower and the proportion of specialized columnar epithelium in each specimen was significantly higher compared with random biopsy. Dysplasia or cancer was diagnosed in significantly more MBDB specimens (12% vs. 6%, p = 0.004), Despite fewer biopsies per patient using MBDB, dysplasia or cancer was diagnosed in significantly more patients (44% vs. 28%, p = 0.03) than by random biopsy technique. MBDB cost less and detected more cancers than random biopsy,Conclusions: MBDB is a more accurate and cost-effective technique than random biopsy for diagnosing specialized columnar epithelium and dysplasia/cancer, particularly in long-segment Barrett's esophagus.