Tehozol MÉ, Manrique MA, Chávez GMÁ, Pérez VE, Zamario FSE, Martínez JR, López GJ, Álvarez CR

Language: Spanish
References: 23
Page: 99-103
PDF size: 143.78 Kb.

ABSTRACT

Actually the term Barrett’s esophagus describes extensive columnar epitelium in the tubular esophagus langer than 3 cm. There are several forms, however the most prevalent is the intestinal metaplasia, which has the biggest displasia and malignancy posibilities. This columnar ephitelium is endoscopically recognized and confirmed by histology. The Barrett’s esophagus consists on two types in relation with the size: Short-segment and large-segment if they are greather than 3 cm or less, in which the histological diagnosis could be confirmed only in 30 to 50% related to the alternancy ephitelium and randomized biopsys. Histologically it can be identified by the presence of globet cells that normally are present in the small bowel and colon but not in the stomach and esophagus. These cells are stained with methylene blue that help to identify it. Methods. Fifteen patients with short-segment Barrett’s esophagus were included and stained with methylene blue. Previous acetilcisteine was applited to make an histological correlation with guided biopsies of the distal esophagus. Results. The application of methylene blue 1% pemits to obtain guided biopsies for hystological studies. The distance of the ectopic columnar mucosa was 0.7 to 2.5 cm with a medium of 1.5 cm from the scamocolummnar union. There were 9 patients identified with reflux oesophagitis, 4 chronic carditis and 6 with Barrett’s esophagus (40%). Conclusion. Chromoendoscopy using methylene blue facilitates the right place to take the biopsies in order to increase the sensitiveness of diagnosis. The presence of intestinal metaplasia is identified because the methylene blue is absorbed by this mucosa. A larger study is required to evaluate the real impact of chromoendoscopy.

REFERENCES

1. Skinner DB, Walther BC, Riddell RH, Schmidt H, Iascone C, DeMeester TR. Barrett’s esophagus: comparison of benign and malignant cases. Ann Surg 1983; 198: 554-65.

2. Spechler SJ, Goyal RK. Barrett’s esophagus. N Engl J Med 1986; 315: 362-71.

3. DeMeester SR, De Meester TR. Columnar mucosa and intestinal metaplasia of the esophagus. Fifty year of controversy. Annals of Surgery 2000; 231: 3-20.

4. Hamilton SR, Smith R, Cameron JL. Prevalence and characteristics of Barrett’s esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction. Hum Pathol 1988; 19: 942-8.

5. Sharma P, Morales TG, Bhattacharyya A, Garewal HS, Sampliner RE. Dysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up. Am J Gastroenterol 1997; 92: 2012-6.

6. McClave SA, Boyce HW, Gottfried MR. Early diagnosis of columnar lined esophagus: a new endoscopic criterion. Gastrointest Endosc 1987; 33: 413-6.

7. Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalovski M. Prospective long-term endoscopic and histological followup of short segment Barrett’s esophagus: comparison with traditional long segment Barrett’s esophagus. Am J Gastroenterol 1997; 92: 407-13.

8. Sampliner RE. The Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 1998; 93: 1028-32.

9. Sharma P, Morales TG, Sampliner RE. Short segment Barrett’s esophagus: the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol 1998; 93: 1033-6.

10. Johnston MH, Hammond AS, Laskin W, Jones DM. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol 1996; 91: 1507-11.

11. Chalasani N, Wo JM, Hunter JG, Waring JP. Significance of intestinal metaplasia in different areas of esophagus including esophagogastric junction. Dig Dis Sci 1997; 42: 603-7.

12. Fennerty MB, Sampliner RE, McGee DL, Hixon U, Garowal HS. Intestinal metaplasia of the stomach: identification by a selective mucosal staining technique. Gastrointest Endosc 1992; 38: 696-8.

13. Canto MF, Setrakian S, Petras RE, Blades E, Chak A, Sivak MV. Methylene blue selectively stains intestinal metaplasia in Barrett’s esophagus. Gastrointest Endosc 1996; 44: 1-7.

14. Fennerty MB. Tissue staining. Gastroenterol Clin N Am 1994; 4: 297-311.

15. Haggitt RC. Barrett’s esophagus, dysplasia, and adenocarcinoma. Hum Pathol 1994; 25: 982-93.

16. Prateek S, Topalovski M, Mayo MS. Weston AP, Methylene blue chromoendoscopy for detection of short-segment Barrett’s esophagus. Gastrointestinal Endoscopy 2001; 54(3): 70-2.

17. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterol 1993; 104: 510-3.

18. Mukunda BR, Mayfield-Stokes S, Cecil B, Forouzandeh B, Davis A, Wilson MA, et al. Results of methylene blue-directed biopsy is similar to conventional biopsy for the diagnosis of intestinal metaplasia and dysplasia in Barrett’s esophagus [abstract]. Gastrointest Endosc 1999; 49: AB54.

19. Gossner L, Pech O, May A, Stolte M, Ell C, Wiesbaden HSK. Methylene blue staining for the detection of dysplasia or mucosal cancer in Barrett’s esophagus -a prospective trial [abstract]. Gastroenterology 1999; 116: G1812.

20. Jobson B, Goenka P, Manalo G, Thomas E. Methylene blue staining for intestinal metaplasia in Barrett’s esophagus -is it as good as we think? [abstract]. Gastrointest Endosc 1999; 49: AB52.

21. Canto MF. Methylene blue staining predicts dysplasia in Barrett’s esophagus [abstract]. Gastrointest Endosc 1999; 49: AB50.

22. Canto MIF, Setrakian S, Willis J, Chak A, Petras R, Powe NR, et al. Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus. Gastrointest Endosc 2000; 51: 560-8.

23. Stevens PD, Lightdale CJ, Green PHR, Siegel LM, Garcia- Carrasquillo RJ, Heidrun R. Combined magnification endoscopy with chromoendoscopy for the evaluation of Barrett’s esophagus. Gastrointest Endosc 1994; 40: 747-9.