INTRODUCTION:
Chronic GERD predisposes to Baretts Metaplasia, dysplasia & adenocarcinoma. Early detection of these lesions is important for making treatment decisions & surveillance stratergies.
AIM OF THE STUDY:
To evaluate and compare the effectiveness of methylene blue chromoendoscopy directed biopsies in the early diagnosis of Barrett’s metaplasia, Dysplasia & early esophageal adenocarcinoma in high risk population compared to routine random biopsy
Place of study: Department of Digestive Health and Diseases, Government Peripheral Hospital, Annanagar , Chennai from April 2013 to February 2014
MATERIALS AND METHODOLOGY:
A total of 50 patients who presented to the Department of Gastroenterology, KMC, Chennai, from April 2013 to February 2014 were included in the study based on inclusion criteria. Each patient underwent routine whitelight and 0.5% methylene blue chromoendoscopy with biopsy as per protocol. Results were assessed and compared for detection of barrett’s metaplasia, dysplasia and adenocarcinoma.
RESULTS:
A total of 50 patients (40 male & 10 female) were included in the study as per inclusion criteria. All the patients included presented with features of GERD, with heartburn (80%) being the most common presentation. Among risk factors, Chronic GERD was seen in all (100%), smoking in (56%) and alcohol intake in (24%). After methylene blue C.E Uniform staining was seen in 11 patients, patchy staining (n=35) and absent staining (n=4). On HPE, the Random biopsy arm detected barrett’s metaplasia in 6% (n=2), whereas the Methylene blue directed biopsy arm detected 10% (n=5, Z test is 0.7372, P – 0.459) with barrett’s metaplasia and 2 of these patients were also found to have low-grade dysplasia (Z is -1.4296, P – 0.153). Out of 5 patients with barrett’s in the MBDB arm, 4 had uniform staining, suggesting that patients with barrett’s metaplasia are likely to have uniform staining.
CONCLUSION:
In our study Methylene Blue Chromoendoscopy and biopsy diagnosed Barrett’s metaplasia to a higher percentage than white light endoscopy and routine biopsy in patients with chronic gastro-oesophageal reflux disease. Hence Chromoendoscopy with Methylene blue is a useful tool for early detection of Barrett’s oesophagus and thereby suggest appropriate treatment and surveillance for oesophageal malignancy
