Brief Article
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World J Gastrointest Endosc. Apr 16, 2013; 5(4): 174-179
Published online Apr 16, 2013. doi: 10.4253/wjge.v5.i4.174
Endocytoscopic visualization of squamous cell islands within Barrett’s epithelium
Nicholas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Toshihisa Hosoya, Roberta Maselli, Shin-ei Kudo
Nicholas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Toshihisa Hosoya, Roberta Maselli, Shin-ei Kudo, Digestive Disease Center, Showa University, Northern Yokohama Hospital, Tsuzuki-ku, Yokohama 224-8503, Japan
Author contributions: Eleftheriadis N wrote the manuscript; Inoue H performed the procedure, designed the study, analyzed and interpreted the data, corrected the manuscript; Ikeda H, Onimaru M, Yoshida A, Hosoya T and Maselli R participated in the procedure and contributed to the analysis and interpretation of data; Kudo S design the study, analyzed and interpreted the data.
Correspondence to: Nicholas Eleftheriadis, MD, Digestive Disease Center, Showa University, Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama 224-8503, Japan. nikoseleftheriadis@yahoo.com
Telephone: +81-45-9497641 Fax: +81-45-9497263
Received: May 24, 2012
Revised: March 11, 2013
Accepted: March 15, 2013
Published online: April 16, 2013
Abstract

AIM: To study the endocytoscopic visualization of squamous cell islands within Barrett’s epithelium.

METHODS: Endocytoscopy (ECS) has been studied in the surveillance of Barrett’s esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for the staining of Barrett’s mucosa. Integrated type endocytoscopes (GIF-Q260 EC, Olympus Corp, Tokyo, Japan) have been recently developed, with the incorporation of a high-power magnifying endocytoscope into a standard endoscope together with narrow-band imaging (NBI). Moreover, double staining with a mixture of 0.05% crystal violet and 0.1% of methylene blue (CM) during ECS enables higher quality images comparable to conventional hematoxylin eosin histopathological images.

RESULTS: In vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett’s epithelium in a patient with long-segment Barrett’s esophagus is reported. Conventional white light endoscopy showed typical long-segment Barrett’s esophagus, with small squamous cell islands within normal Barrett’s mucosa, which were better visualized by NBI endoscopy. ECS after double CM staining showed regular Barrett’s esophagus, while higher magnification (× 480) revealed the orifices of glandular structures better. Furthermore, typical squamous cell papillary protrusion, classified as endocytoscopic atypia classification (ECA) 2 according to ECA, was identified within regular glandular Barrett’s mucosa. Histological examination of biopsies taken from the same area showed squamous epithelium within glandular Barrett’s mucosa, corresponding well to endocytoscopic findings.

CONCLUSION: To our knowledge, this is the first report of in vivo visualization of esophageal papillary squamous cell islands surrounded by glandular Barrett’s epithelium.

Keywords: Endocytoscopy, Barrett’s esophagus, Surveillance, Endocytoscopic atypia classification, Crystal violet, Methylene blue, Hematoxylin eosin stain

Core tip: Endocytoscopy has been also studied in surveillance of Barrett’s esophagus, with controversial results. In initial studies, however, a soft catheter type endocytoscope was used, while only methylene blue dye was used for staining of Barrett’s mucosa. In the present study, in vivo endocytoscopic visualization of papillary squamous cell islands within glandular Barrett’s epithelium in a patient with long-segment Barrett’s esophagus is reported.