Letters to the EditorEndoscopic diagnosis of intestinal metaplasia
References (4)
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Scanning electron microscopy of intestinal metaplasia of the human stomach
Gastrointest Endosc
(1983) - H. Meshkinpour et al.
Significance of endoscopically visible blood vessels as an index of atrophic gastritis
Am J Gastroenterol
(1979)
Cited by (20)
External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions
2008, Gastrointestinal EndoscopyConventional endoscopy has low sensitivity, specificity, and interobserver agreement for the diagnosis of gastric atrophy, intestinal metaplasia, and dysplasia. Magnification chromoendoscopy (ME) may optimize the evaluation of premalignant gastric lesions.
As part of a multicenter trial, we aimed at validating a previously proposed classification for gastric methylene blue ME at a different center.
A sample of patients (n = 42) with previously diagnosed chronic atrophic gastritis with or without intestinal metaplasia underwent ME (Pentax EG-3430Z) with 1% methylene blue by 2 endoscopists.
A simplified version of a previously published ME classification (group I, group II [further divided into subgroups IIE and IIF], and group III) was used for macroscopic lesions (n = 203) with Sydney-Houston and Vienna classifications being used for histologic analysis (n = 479 biopsy specimens).
Excellent reproducibility (wK = 0.92 [95% CI, 0.88-0.96]) was observed for classification in groups and substantial reproducibility (wK = 0.78 [95% CI, 0.72-0.84]) was found for classification in subgroups. Global validity was 82% (range 78%-86%), showing no false negatives (sensitivity of 100% [1/1 biopsy]) and a very low rate of false positives (specificity 99% [297/299 biopsies]) for dysplasia detection.
This classification for methylene blue ME was highly reproducible and valid for the diagnosis of premalignant gastric lesions when used in a center different from that involved in its conception. Despite requiring an unconventional endoscope and a longer procedure, these results could reinforce ME as a valuable technique in the surveillance of patients at risk for gastric cancer.
Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia
2003, Gastrointestinal EndoscopyBackground: The aim of this study was to define the reproducibility and accuracy of magnification chromoendoscopy for the diagnosis of lesions associated with gastric cancer (intestinal metaplasia and dysplasia).
Methods: A total of 136 patients with previously diagnosed lesions and 5 gastrectomy specimens were studied. Endoscopic examination was performed with a magnification endoscope after methylene blue (1%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies taken (n=462). Five endoscopists were asked to classify individually 2 endoscopic images per subgroup on 2 separate occasions.
Results: Three groups of endoscopic images were defined: nonmetaplastic, nondysplastic mucosa (I); metaplastic mucosa (II); and dysplastic mucosa (III). Ten subgroups were defined according to pit pattern: round small (IA), round and tubular small (IB), coarse round (IC), and course round pits with a straight pit (ID); blue irregular marks (IIA), blue round and tubular pits (IIB), blue villi (IIC), and blue small pits (IID); and loss of clear pattern, with depression (IIIA) or with slight elevation (IIIB). The kappa statistic for intraobserver agreement on the classification of endoscopic images in groups was 0.86; for interobserver agreement, it was 0.74. For classification into subgroups, kappa values ranged from 0.48 to 0.78. For 85% of the areas classified endoscopically as Group I (n=146), no mucosal lesions or gastritis was described at histologic examination; for 83% of those in Group II (n=198), intestinal metaplasia was found. Subgroups IIA and IIB were more often associated with complete intestinal metaplasia (62%), and IIC and IID with incomplete metaplasia (67%); in Group III (n=118), dysplasia was diagnosed histopathologically in 33%. For the diagnosis of dysplasia, specificity was 81% (95% CI [77%, 85%]) and negative predictive value 99% (95% CI [99%, 100%]).
Conclusions: Gastric endoscopic patterns with chromoendoscopy and magnification seem reproducible and valid for the diagnosis of lesions associated with gastric cancer. This procedure may improve the follow-up of individuals at high-risk of gastric cancer, at least for the exclusion of severe lesions.
Methylene blue selectively stains intestinal metaplasia in Barrett's esophagus
1996, Gastrointestinal EndoscopyBackground: Specialized columnar epithelium in Barrett's esophagus resembles gastric intestinal metaplasia, which selectively stains with methylene blue. Methods: We prospectively evaluated the safety, accuracy, reproducibility, cost, and diagnostic yield of methylene blue–directed biopsy in detecting specialized columnar epithelium and dysplasia in Barrett's esophagus. We performed upper endoscopy with methylene blue–directed biopsy and obtained 236 large cup biopsy specimens (145 stained, 91 unstained) from 14 patients with Barrett's esophagus of any length (Group 1) and 12 control patients. Biopsy specimens were independently examined by two pathologists unaware of the endoscopic results. Results: Methylene blue stained specialized columnar epithelium in 18 of the 26 patients, including those with intramucosal carcinoma (1), high-grade dysplasia (1), and indefinite/low-grade dysplasia (6). Methylene blue staining pattern, which was focal in 72% and diffuse in 28% of patients, was reproduced in 8 patients who had repeat staining within 4 weeks. The overall accuracy of methylene blue staining for detecting specialized columnar epithelium was 95%. The diagnostic yield of methylene blue staining for specialized columnar epithelium in “control” patients was 42%. The risk for dysplasia in stained biopsy specimens was greater than in unstained ones (odds ratio 17.7, p = .0004). Conclusions: Methylene blue mucosal staining is a safe, inexpensive, reproducible, and highly accurate method of diagnosing specialized columnar epithelium in Barrett's esophagus. (Gastrointest Endosc 1996;44:1-7.)
Tissue staining
1994, Gastrointestinal Endoscopy Clinics of North AmericaTissue staining has broad clinical and research application. Although routinely practiced in other countries, tissue staining is rarely performed in the United States. This article deals with the use of absorptive stains (Lugol’s solution, indocyanine green, toluidine blue, methylene blue); reactive stains (Congo red), contrast stains (indigo carmine); tissue tattooing; and fluorescent staining. It is possible that the development of novel stains and fluorescent substances could be used to detect specific epitheliums (such as malignancy and dysplasia).
Intestinal metaplasia of the stomach: identification by a selective mucosal staining technique
1992, Gastrointestinal EndoscopyThe Mexican consensus on the detection and treatment of early gastric cancer
2020, Revista de Gastroenterologia de MexicoEl cáncer gástrico representa una de las neoplasias más frecuentes en el aparato digestivo y en la mayoría de los casos es el resultado de la progresión de lesiones premalignas. La detección oportuna de estas lesiones es relevante ya que un tratamiento oportuno brinda la posibilidad de curación. En nuestro país no existía un consenso respecto a la detección temprana del cáncer gástrico, por lo que la Asociación Mexicana de Gastroenterología reunió a un grupo de expertos y realizó el Consenso sobre detección y tratamiento del cáncer gástrico incipiente (CGI) para establecer recomendaciones de utilidad para la comunidad médica. En este consenso se utilizó la metodología Delphi y se emitieron 38 recomendaciones al respecto del CGI. El consenso define el CGI como aquel que al momento del diagnóstico se encuentra limitado a la mucosa y a la submucosa, independientemente de metástasis en ganglios linfáticos. En México, como otras partes del mundo, los factores asociados al CGI incluyen la infección por Helicobacter pylori, los antecedentes familiares, el tabaquismo y los factores dietéticos. Para el diagnóstico se recomienda utilizar cromoendoscopia, magnificación y equipos con luz mejorada. Un diagnóstico histopatológico preciso es invaluable para tomar de decisiones terapéuticas. El tratamiento endoscópico del CGI, ya sea disección o resección de la mucosa, debe ser preferido al manejo quirúrgico cuando se puedan obtener resultados semejantes en términos de curación oncológica. La vigilancia endoscópica se deberá de individualizar.
Gastric cancer is one of the most frequent neoplasias in the digestive tract and is the result of premalignant lesion progression in the majority of cases. Opportune detection of those lesions is relevant, given that timely treatment offers the possibility of cure. There is no consensus in Mexico on the early detection of gastric cancer, and therefore, the Asociación Mexicana de Gastroenterología brought together a group of experts and produced the “Mexican consensus on the detection and treatment of early gastric cancer” to establish useful recommendations for the medical community. The Delphi methodology was employed, and 38 recommendations related to early gastric cancer were formulated. The consensus defines early gastric cancer as that which at diagnosis is limited to the mucosa and submucosa, irrespective of lymph node metástasis. In Mexico, as in other parts of the world, factors associated with early gastric cancer include Helicobacter pylori infection, a family history of the disease, smoking, and diet. Chromoendoscopy, magnification endoscopy, and equipment-based image-enhanced endoscopy are recommended for making the diagnosis, and accurate histopathologic diagnosis is invaluable for making therapeutic decisions. The endoscopic treatment of early gastric cancer, whether dissection or resection of the mucosa, should be preferred to surgical management, when similar oncologic cure results can be obtained. Endoscopic surveillance should be individualized.