A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus

Abstract

A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett's esophagus Abstract This study was designed to examine the shortfalls of methylene blue-directed biopsies (MBDB) and conventional random biopsies (RB) in the surveillance of Barrett's esophagus. A Cochrane and Medline search was performed, and fi ve randomized controlled trials (RCTs) comprising 213 patients were selected for the meta-analysis. Random biopsies failed to spot specialized intestinal metaplasia (SIM) in a signifi cantly higher number of patients than MBDB (risk ratio, 0.724; confi dence interval, 0.552-0.950). The rate of underdiagnosis of dysplasia was comparable between the two techniques (risk ratio, 0.766; confi dence interval, 0.273-2.147). More biopsies were obtained using the RB technique, and a signifi cantly higher number of biopsies was reported as normal in comparison to MBDB (P = 0.014). The use of endoscopic staining was associated with prolongation of the procedure time (P = 0.009). It was concluded that SIM is overlooked more often in conventional biopsy techniques, but the incidence of undetected dysplasia is comparable using both methods. The routine use of methylene blue in the surveillance of Barrett's esophagus seems to be unnecessary.

Australian clinical practice guidelines for the diagnosis and management of Barrett's esophagus and early esophageal adenocarcinoma

“…Intestinal metaplasia can be patchy and may not be consistently sampled with endoscopic biopsies (level of evidence IV). Advancements in chromoendoscopy (methylene blue, indigo carmine, and acetic acid), endoscope digital enhancements (narrow‐band imaging, i‐SCAN, Fujinon intelligent chromo endoscopy), and enhanced magnification have not been shown to be superior to the currently accepted practice of random four‐quadrant biopsies at 2‐cm intervals (levels of evidence I, II, IV, respectively); however, the diagnostic yield may be higher with increasing number of biopsies (level of evidence IV) . Jumbo biopsy forceps have not been shown to be superior to standard capacity forceps in obtaining adequate biopsy samples (level of evidence II) .…”

Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients With Barrett's Esophagus: A Meta-analysis and Systematic Review

“…Three previous meta-analyses addressed the issue of chromoendoscopy (including VC) and Barrett's esophagus, but looked at VC or CE and not both. 37-39 One of those studies dealt with tests characteristics like sensitivity, specificity, and accuracy. While such measures are frequently reported for endoscopic procedures, the true disease status (a ‘gold standard’) for any given patient is typically not known.…”

Advances in the management of Barrett’s esophagus and early esophageal adenocarcinoma

“…Initial studies using methylene blue showed that application of this substance increased the detection of intestinal metaplasia as well as advanced histology (HGD and IMC) [ 33–36 ], but other studies showed no incremental yield from its use [ 37 , 38 ]. Two meta-analyses addressed this issue and neither found any benefit of methylene blue over random four-quadrant biopsies [ 39 , 40 ]. Similarly, both indigocarmine—a contrast stain—and acetic acid—a contrast-enhancing agent—have shown promising results in improving the detection of advanced histology [ 33 , 41–46 ], but dye-based chromoendoscopy is currently not recommended for routine use in surveillance of Barrett’s epithelium.…”