1. Methylene blue chromoendoscopy for Barrett's esophagus: Coming soon to your GI unit? 
Marcia Irene Canto, MD, MHS 
Gastrointestinal Endoscopy 
Volume 54, Issue 3, Pages (September 2001)
DOI: /mge
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions

2. Fig. 1
A, Endoscopic view of focal methylene blue staining of nondysplastic specialized intestinal metaplasia in an ultrashort tongue of columnar mucosa (arrow) and under the Z line. B, Endoscopic view of diffuse, homogeneous staining of a short circumferential length of nondysplastic specialized intestinal metaplasia in nondysplastic Barrett's esophagus. Biopsy specimens from the small unstained area (arrow) showed gastric-type metaplasia.
Gastrointestinal Endoscopy  , DOI: ( /mge )
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions

3. Fig. 2
A, Endoscopic views of nondysplastic long Barrett's esophagus with diffuse, homogeneous staining. B, Endoscopic view of long Barrett's esophagus without an associated lesion showing multiple, focal unstained areas (yellow arrows) within heterogeneously stained mucosa (“speckled” appearance) within the proximal portion. Specimens from these abnormally stained areas showed specialized intestinal metaplasia with high-grade dysplasia. No dysplasia was found elsewhere in multiple specimens from the stained Barrett's esophagus.
Gastrointestinal Endoscopy  , DOI: ( /mge )
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions

4. Fig. 3
Endoscopic views of short length of columnar-lined esophagus before (A) and after (B) methylene blue staining. A prior endoscopy procedure with random biopsy technique disclosed only gastric-type metaplasia. After methylene blue staining, there is no significant positive staining, indicating the absence of intestinal metaplasia, which was confirmed by multiple biopsies. The small amount of dye visible in the hiatal hernia refluxed from the stomach.
Gastrointestinal Endoscopy  , DOI: ( /mge )
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions

5. Fig. 4
A, Photomicrograph showing nondysplastic distinctive Barrett's esophagus (intestinal metaplasia) with the characteristic crypts and villi lined by mucus-secreting columnar cells and goblet cells (H&E, orig. mag. ×100). With increasing grade of dysplasia, there is loss of goblet cells and increased ratio of nuclei to cytoplasm. B, Photomicrograph showing severely dysplastic Barrett's esophagus; methylene blue is not readily absorbed into cells and results in decreased to absent staining.
Gastrointestinal Endoscopy  , DOI: ( /mge )
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions

6. Fig. 5
A, Endoscopic views of Barrett's esophagus with no apparent lesion after methylene blue staining performed during routine endoscopic surveillance. Methylene-blue directed biopsy specimens from 2 focal, confluent areas of unstained columnar mucosa identified low-grade dysplasia in a tongue (A) and high-grade dysplasia in an island (B). Note homogeneous dark blue staining of adjacent nondysplastic specialized intestinal metaplasia.
Gastrointestinal Endoscopy  , DOI: ( /mge )
Copyright © 2001 American Society for Gastrointestinal Endoscopy Terms and Conditions