Barrett’s esophagus is one of the more serious consequences of gastroesophageal reflux disease. Barrett’s esophagus originally referred to any columnar metaplasia of the esophageal epithelium [1, 2]. Since 1998, the diagnosis of Barrett’s esophagus has been restricted to an intestinal metaplasia of the esophagus in which goblet cells are present [3]. Because this intestinal metaplasia has a 10% risk of progressing to adenocarcinoma of the esophagus [3, 4], accurate diagnosis is essential. While endoscopy may create a strong suspicion of the presence of intestinal metaplasia, definitive diagnosis requires microscopic identification of goblet cells in the esophageal epithelium [5–7]. Although goblet cells can be identified in H&E sections, diagnostic accuracy is improved by staining the acidic mucins of the goblet cells with alcian blue [8, 9]. Even studies that have concluded that special staining of the acidic mucins is not always necessary for the diagnosis of Barrett’s esophagus have admitted that it is sometimes necessary [7].
The supply of alcian blue has been erratic. The quality of some lots of alcian blue has been unacceptable for histological purposes [10, 11, 12]. Periodically, alcian blue has disappeared from the market altogether [13, 14]. Colloidal iron can be used as a substitute for alcian blue [15], but the working solution is short-lived [15, 16]. Preparing a good stock solution of colloidal iron is time-consuming [17, 18]. Workers who recommend quick procedures for preparing the stock solution often report erratic staining results [19, 20]. This has also been the authors’ experience.
Zirconyl hematoxylin also stains acidic mucins [21, 22]. While the staining intensity of the original formulation is adequate for aiding in the diagnosis of adenocarcinoma of the prostate [22], it is too pale for rapid screening of esophageal biopsies. A recent improvement in the formulation of zirconyl hematoxylin [14] markedly increases the intensity of the stain. The efficacy of the improved zirconyl hematoxylin in the diagnosis of Barrett’s esophagus was tested and compared to the efficacy of alcian blue.
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