Original article
Clinical endoscopy
Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis

https://doi.org/10.1016/j.gie.2008.06.056Get rights and content

Background

The reported yield of methylene-blue (MB) chromoendoscopy targeted biopsy in detecting specialized intestinal metaplasia (SIM) and, more importantly, dysplasia in patients with Barrett's esophagus (BE) has shown variable results.

Objective

To perform a meta-analysis of published studies for assessment of the diagnostic yield of techniques of chromoendoscopy compared with conventional 4-quadrant random biopsy (RB) in detection of SIM and dysplasia in patients with BE.

Design

A literature search of the MEDLINE, EMBASE, and the Cochrane Databases was performed, along with a search of PubMed and a manual search of cross-references of eligible articles. Data on yield of both modalities were extracted and analyzed to estimate weighted incremental yield (IY) and 95% CIs of MB over RB using a fixed-effects or random-effects model, as appropriate, based on whether homogeneity or heterogeneity, respectively, was indicated by Cochrane's Q χ2 test.

Patients

A total of 450 patients with BE were reported in 9 studies included in the meta-analysis.

Results

There was no significant IY with MB over RB for detection of SIM (IY 4%; 95% CI, -7% to 16%; 6 studies, n = 251), dysplasia (IY 9%; 95% CI, -1% to 20%; 9 studies, n = 450), and high-grade dysplasia and/or early cancer (IY 5%; 95% CI, -1% to 10%; 8 studies, n = 405).

Limitations

Only data on MB were analyzed because of limited availability of data for other chromoendoscopy dyes, minor variations in inclusion and exclusion criteria, and the small sample size, and because differences in application technique could have led to an underestimation of the diagnostic yield of MB chromoendoscopy.

Conclusion

The technique of MB chromoendoscopy has only a comparable yield with RB for the detection of SIM and dysplasia during endoscopic evaluation of patients with BE.

Section snippets

Materials and methods

By using the MEDLINE, EMBASE, and Cochrane Central Trials databases from January 1980 through October 2007, a thorough literature search for prospective trials that compared MB chromoendoscopy with standard RB for detection of SIM and dysplasia in patients with BE was conducted, along with an additional search of PubMed and a manual search of cited references in selected articles. We used the following text words as search terms: Barrett's esophagus, Barrett's oesophagus, methylene blue

Results

Seventy-four articles were initially identified by using the search strategy described (Fig. 1). Fifty-one articles (clinical reviews [n = 39], editorials [n = 8], and brief communications or letters to the editors [n = 4]) were excluded after preliminary review, which left 23 articles for detailed evaluation. Of these, 8 published articles that met the inclusion criteria were identified.10, 11, 12, 13, 14, 15, 16, 17 One additional abstract was identified by hand search.18 In total, 9 studies

Discussion

Our meta-analysis found no significant difference in yield of MB chromoendoscopy over RB for detection of SIM, LGD, and, more importantly, for detection of HGD and EAC. Application of the technique of MB chromoendoscopy during endoscopic surveillance of patients with BE is controversial. None of the current practice guidelines recommend routine use of chromoendoscopy during endoscopic surveillance of BE, and some experts point out that MB chromoendoscopy is a tedious, cumbersome technique, with

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

Presented at Digestive Disease Week 2008, May 17-22, 2008, San Diego, California (Gastrointest Endosc 2008;67:AB172).

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See CME section; p. 1148.

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