Methylene Blue–Directed Biopsy vs. 4-Quadrant Biopsy for BE

Which approach is more effective for identifying dysplasia in Barrett esophagus?

The most recent guidelines from the American College of Gastroenterology concerning Barrett esophagus (BE) reaffirm that a diagnosis of BE should be based on endoscopic appearance and confirmed by identification of specialized intestinal metaplasia (SIM) through biopsy of the tubular esophagus. These guidelines recommend that, in the absence of known dysplasia or focal mucosal irregularity, conventional 4-quadrant biopsy samples be taken every 2 cm of columnar-lined esophagus. The primary concern with this “blind” biopsy technique is that dysplasia can be missed because of sampling error. To avoid such errors, some endoscopists identify targeted areas for biopsy using methylene blue (MB) staining, which binds to areas of intestinal metaplas…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors