We agree with Ragunath and Krasner that our study showed lower specificity and sensitivity for methylene blue staining in detecting intestinal metaplasia than the studies by Canto et al. and Kiesslich et al.
1
, 3
We clearly admit the limitations of our study in the article: a small number of patients, evaluation of patient discomfort in the absence of a validated patient questionnaire, and possible retrograde amnesia caused by midazolam use.1
The key message of our study was that there is a potential risk of spraying a large volume of liquid in the esophagus. We agree that with increased experience in the staining technique, the sensitivity and specificity of staining in detection of intestinal metaplasia and the time for staining may possibly improve. We are concerned regarding the complete safety of spraying a large volume of liquid during a prolonged endoscopy with the patient under sedation or with the use of topical pharyngeal anesthesia induced by spraying local anesthetic.
Recently the value of surveillance in Barrett's esophagus is being questioned.
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We strongly feel that any surveillance procedure that is associated with a potentially serious adverse effect should be very carefully evaluated before it is adopted in clinical practice.References
- Methylene blue staining: is it really useful in Barrett's esophagus?.Gastrointest Endosc. 2001; 53: 333-335
- Methylene blue selectively stains intestinal metaplasia in Barrett's esophagus.Gastrointest Endosc. 1996; 44: 1-7
- Screening for specialized columnar epithelium with methylene blue: chromoendoscopy in patients with Barrett's esophagus and a normal control group.Gastrointest Endosc. 2001; 53: 47-52
- Final results from a ten year cohort of patients undergoing surveillance for Barrett's metaplasia: observational study.BMJ. 2000; 48: 1252-1255
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© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
