| Barrett's esophagus is a condition in which the normal stratified squamous epithelium of the esophagus is replaced by specialized intestinal metaplasia, that carries an increased risk for the development of adenocarcinoma of the esophagus. it was deduced that the incidence of BE was about 1% to 1.5% in nature population,but the incidence of Barrett's esophagus was 376 per ten thousand in a group of autopsy for 18 months and it was 20 times more than the rate of clinic diagnosis on the same stage according to an prospective observation. It is obvious that actual incidence of BE is more than it has been reported. In China, there are few reports about the incidence of BE, especially in primary hospitals, the reasons of it may be: (1) BE is not primary encountered disease and frequency encountered disease; (2) At the same time, in the situation of pathological form the variety of tiny focus make it difficult to take a biopsy well and truly just at rountine endoscopy for endoscopic doctors.Methylene blue has been used to selectively stain areas of specialized intestinal metaplasia having absouption function and appearsing blue and direct biopsy, other cells cannot been stained, such as squamous epithelium of esophagus and intestinal epithelium of gaster. With the deep development of research on BE, the researches are not limited on LSBE, there are a few of researches about intestinal metaplasia of SSBE,normal EGJ and cardia. Although the distal esophageal intestinal metaplasia and the gastric cardia intestinal metaplasia are considered as the premalignant lesion,they have different pathological developing process, the diagnosis of BE that it's biopsy areas are not definited depends on not only finding SIM but also definiting the origin of intestinal metaplasia. These requests make the diagnosis of BE become more difficult. It has been suggested that Barrett's epithelium and intestinal metaplasia in the gastric cardia have different cyotokeratin (CK) staining patterns and that Barrett's epithelium can be distinguished by CKstaining pattern., the BE CK7/20 pattern can solve this difficult problem. In this study we use endoscopic esophageal mucosa dyeing incorporating with biopsy and immunostaining of CK7/CK20 to improve the diagnostic rate of BE. 30 cases of BE and 30 cases with abnormal appearance of cardia were selected by endoscopy, then those cases were divided into subgroup before dyeing (comparing group) and subgroup after dyeing (testing group). The patients of BE were diagnosed according to diagnosis criteria of BE Congress of American Gastroenterological Association (AGA) in 1998. In comparing group,the tissue specimens of esophageal and cardic mucosa were taken 3-5 pieces from abnormal apparences. then dyed the distal esophagus and cardia with Methylene blue, took the tissue specimens of esophageal and cardic mucosa which have been stained into blue were taken 3-5pieces. Some cases would been grouped again depend on finding SIM on pathology, BE was testing group and cardia,gaster's intestinal metaplasia with goblet cell which have been approved was comparing group,all of cases of two groups were stained by ck7 and ck20 immunostaining to determine the use of CK7 and CK20 expression in the histological distinction of BE from gastric intestinal metaplasia that contains goblet cells. The criterion of BE pattern is Diffuse strong CK7 staining of surface epithelium and deep glands. CK20 staining of superficial epithelium. Absent immunoreactivity of deep glands. The results were described below: (1) In cases of BE: the detection rates of BE were respectively 70% and93.33% in subgroup before dyeing and subgroup after dyeing, there were significant difference between them (p<0.05). The detection rates of SIM of tissue specimens were 57.85% in subgroup before dyeing and 83.67% in subgroup after dyeing, X2=19.98 P<0.005. In cases of cardia: the detectoin rates of patients with SIM were not significant difference between subgroup before dyeing and subgroup after dyeing. But The detection rates of SIM of tissue specimens were 2.04% in subgroup before dyeing and 55.56% in subgroup after dyeing, there were significant difference between them (p<0.05). (2) A Barrett's CK7/20 pattern was present in most patients, the rates were 96.43%. this pattern was absent in all 3 patients with intestinal metaplasia of cardia.and all 12 patients with intestinal metaplasia of gaster.Conclusion:1. Methylene blue mucosa dyeing and directing biopsy may improve the diagnostic rate of SIM and BE. 2. The immunohistochemical determination of CK7/20 is an excellent marker with high specificity and sensitivity in diagnosis BE. It may exclude false positive of diagnosis of BE.3. endoscopic esophageal mucosa methylene blue dyeing incorporating with immunohistochemial examination of CK7/20 may improve the diagnostic rate of BE...
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