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Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis.
Gastrointest Endosc 2009; 69(6):1021-8GE

Abstract

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 chi(2) 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.

Authors+Show Affiliations

Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

19215918

Citation

Ngamruengphong, Saowanee, et al. "Diagnostic Yield of Methylene Blue Chromoendoscopy for Detecting Specialized Intestinal Metaplasia and Dysplasia in Barrett's Esophagus: a Meta-analysis." Gastrointestinal Endoscopy, vol. 69, no. 6, 2009, pp. 1021-8.
Ngamruengphong S, Sharma VK, Das A. Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis. Gastrointest Endosc. 2009;69(6):1021-8.
Ngamruengphong, S., Sharma, V. K., & Das, A. (2009). Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis. Gastrointestinal Endoscopy, 69(6), pp. 1021-8. doi:10.1016/j.gie.2008.06.056.
Ngamruengphong S, Sharma VK, Das A. Diagnostic Yield of Methylene Blue Chromoendoscopy for Detecting Specialized Intestinal Metaplasia and Dysplasia in Barrett's Esophagus: a Meta-analysis. Gastrointest Endosc. 2009;69(6):1021-8. PubMed PMID: 19215918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis. AU - Ngamruengphong,Saowanee, AU - Sharma,Virender K, AU - Das,Ananya, Y1 - 2009/02/11/ PY - 2008/04/02/received PY - 2008/06/23/accepted PY - 2009/2/14/entrez PY - 2009/2/14/pubmed PY - 2009/8/7/medline SP - 1021 EP - 8 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 69 IS - 6 N2 - 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 chi(2) 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. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/19215918/Diagnostic_yield_of_methylene_blue_chromoendoscopy_for_detecting_specialized_intestinal_metaplasia_and_dysplasia_in_Barrett's_esophagus:_a_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(08)02181-0 DB - PRIME DP - Unbound Medicine ER -