indigo-carmine and Adenoma

Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer. Performing periodic dysplasia screening and surveillance may diminish this risk. To date, chromoendoscopy is the only technique that has consistently yielded positive results in large, well-designed dysplasia-detection trials. Most major society guidelines endorse chromoendoscopy as an adjunct, accepted, or preferred dysplasia-detection tool. This review outlines the available endoscopic technologies for the detection of dysplasia in IBD, considers the evidence supporting their use, and assesses which modalities are ready for use in clinical practice.

Topics: Adenoma; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Humans; Indigo Carmine; Inflammatory Bowel Diseases; Intestinal Mucosa; Methylene Blue; Microscopy, Confocal; Narrow Band Imaging; Optical Imaging

Colonoscopy, the most sensitive test used to detect advanced adenoma and cancer, has been shown to prevent colorectal cancer (CRC) when combined with polypectomy. CRC remains the third most commonly diagnosed cancer and the second leading cause of cancer death in men and women in the United States. Image-enhanced endoscopy (IEE) is an integral part in the detection, diagnosis, and treatment of non-polypoid colorectal neoplasms. Both the dye-based and equipment-based varieties of IEE are readily available for application in today's practice of colonoscopy. Data are available to support its use, although further studies are needed to simplify the classification of colorectal lesions by the different techniques of equipment-based IEE.

Topics: Adenoma; Colitis, Ulcerative; Colonic Polyps; Colonoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis; Early Detection of Cancer; Fluorescent Dyes; Gentian Violet; Humans; Image Interpretation, Computer-Assisted; Indigo Carmine; Mass Screening

Since the adenoma-carcinoma sequence was first proposed by Morson in the 1970s, it has become widely accepted that detection and subsequent removal of polypoid adenomas from the colon reduces the incidence of colorectal cancer. These adenomas are relatively easy to detect by conventional colonoscopy; however, large population studies have shown that despite resection of polypoid adenomas, interval colorectal cancers still occurred. Recent advances in technology have given today's endoscopists access to high-resolution and high-magnification scopes, which has facilitated detection of flat and depressed colorectal lesions. Current data suggest that such morphologically distinct lesions may account for up to 30% of all colorectal adenomas. Furthermore, flat and depressed lesions of the large bowel may confer greater malignant potential compared to polypoid adenomas. The majority of flat lesions show only subtle changes by conventional colonoscopy, but the use of stains, such as indigocarmine, in addition to magnification colonoscopy can enhance their detection significantly. In this paper, we discuss the rationale for detecting flat colorectal lesions. We explore the use of high-magnification colonoscopy and chromoendoscopy, with particular reference to the application of indigocarmine, in this patient group. We also discuss the novel therapeutic techniques now available for these lesions.

Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Carcinoma; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged

Endoscopic techniques aimed at early detection of colorectal cancer (CRC) and its precursors, permitting targeted in vivo luminal treatments, have been developed by the Japanese since the early 1990s. The introduction of this new technology to the UK (i.e. magnification endoscopes) may permit earlier and more accurate diagnosis. According to Japanese data, magnification chromoscopy can be used to predict histology and invasive depth of cancer, and help in the detection of flat and depressed colonic lesions. Flat and depressed lesions are not purely Japanese phenomena: they exist with a similar incidence in the UK.. A Medline search was performed for the years 1955-2001 using the following medical subject headings and search methodology: colorectal cancer and colonoscopy or aberrant crypt foci or molecular kinetics or flat/depressed lesions or chromoscopy.. Early CRC, in the form of flat or depressed lesions, can be difficult to detect using conventional colonoscopic techniques and penetrate the colonic mucosa deeply. The implications of detecting these lesions in relation to current approaches to the prevention of CRC are profound.

Topics: Adenoma; Colonoscopy; Colorectal Neoplasms; Contrast Media; Gentian Violet; Humans; Indigo Carmine

colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy.. prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy.. In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001.. the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.

Topics: Adenoma; Cecum; Colon, Ascending; Colonic Polyps; Colonoscopy; Humans; Indigo Carmine; Prospective Studies

Colonoscopic screening with indigo carmine chromoendoscopy (ICC) in patients with Lynch syndrome (LS) improves the adenoma detection rate but is time consuming and poorly used in clinical practice. Narrow-band imaging (NBI), a virtual chromoendoscopy technique, highlights superficial mucosal vessels and improves adenoma characterization. We conducted a prospective multicenter trial in a back-to-back fashion to compare the third-generation NBI with ICC for detecting colonic adenomas in patients with LS.. In a multicenter, prospective, noninferiority trial, 138 patients underwent a double colonoscopy, first with NBI, followed by ICC, in a back-to-back design. The primary noninferiority outcome measure was the number of patients with at least one adenoma after NBI compared with the number of patients with at least one adenoma after NBI and ICC.. The 138 analyzable patients were all proven mismatch repair mutation carriers for LS (MLH1 = 33%, MSH2 = 47%, MSH6 = 15%, PMS2 = 4%, and EPCAM = 1%). The mean age (SD) was 40.5 (14.7) years, and 64 (46.4%) were men. The median withdrawal time for an NBI procedure was 8 minutes (interquartile range 6-11) compared with 13 minutes (interquartile range 8-17) for ICC. At least one adenoma was detected during the initial NBI pass in 28 patients (20.3%), and 42 patients (30.4%) had at least one adenoma detected after both NBI and ICC (difference, 10.1%; 95% confidence interval, -0.1%-20.3%); this represents an increase of 50.0% of the adenoma detection rate. ICC detected additional adenomas in 25 patients (18.1%).. Colonoscopy combining NBI and ICC detects more adenomas than third-generation NBI alone in patients with LS, respectively, 30.4% vs 20.3% (difference, 10.1%; 95% confidence interval, -0.1 to 20.3), thus failing the noninferiority assumption of NBI compared with combined NBI and ICC. Although less time consuming, colonoscopy using the third-generation NBI cannot be recommended to replace ICC in patients with LS.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colon; Colonography, Computed Tomographic; Colonoscopy; Color; Colorectal Neoplasms, Hereditary Nonpolyposis; Coloring Agents; Female; Humans; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Narrow Band Imaging; Prospective Studies; Time Factors; Young Adult

Serrated polyposis syndrome (SPS), characterized by multiple and/or large proximal serrated lesions, increases the risk of colorectal cancer. Serrated lesions often are missed during colonoscopy but panchromoendoscopy can increase their detection in an average-risk population. We performed a randomized controlled study to determine the efficacy of panchromoendoscopy in detection of polyps in patients with SPS.. Patients with SPS (n = 86 patients) underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. Patients were assigned randomly to groups that received 2 HD white-light endoscopy examinations (HD-WLE group; n = 43) or HD-WLE followed by 0.4% indigo carmine panchromoendoscopy (HD-CE group; n = 43). For each procedure, polyps detected were described, removed, and analyzed by histology. The primary outcome was additional polyp detection rate, defined as the number of polyps detected during the second inspection divided by the total number of polyps detected during the first and the second examination.. A total of 774 polyps were detected (362 in the HD-WLE group and 412 in the HD-CE group); 54.2% were hyperplastic, 13.8% were adenomas, and 10.9% were sessile serrated polyps. There was a significantly higher additional polyp detection rate in the HD-CE group (0.39; 95% CI, 0.35-0.44) than in the HD-WLE group (0.22; 95% CI, 0.18-0.27) (P < .001). A higher additional rate of serrated lesions proximal to the sigmoid colon were detected in the second inspection with HD-CE (0.40; 95% CI, 0.33-0.47) than with HD-WLE (0.24; 95% CI, 0.19-0.31) (P = .001). Detection of adenomas and serrated lesions greater than 10 mm did not differ significantly between groups. In a multivariate logistic regression analysis, only use of HD-CE was associated independently with increased polyp detection throughout the colon.. In a randomized controlled trial, we found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered the standard of care in patients with SPS. Studies are needed to determine the effects of this strategy on the incidence of advanced neoplasia during long-term follow-up evaluation. ClinicalTrials.gov no: NCT03476434.

Topics: Adenoma; Adenomatous Polyps; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Syndrome

Patients with Lynch syndrome (LS) undergo regular surveillance by colonoscopy because of an increased risk of colorectal neoplasia, particularly in the proximal colon. Chromoendoscopy (CE) has been reported to improve neoplasia detection compared with conventional white-light endoscopy (WLE), but evidence is limited. Our aim was to investigate the effect of CE in the proximal colon on detection of neoplastic lesions during surveillance in LS.. This was a multicenter prospective randomized controlled trial of 246 patients with LS who were randomly assigned (1:1) to conventional WLE (n = 123) or colonoscopy with CE in the proximal colon (n = 123), stratified for previous colorectal adenomas and enrolling center. Two years after baseline colonoscopy, patients underwent colonoscopy with CE in the proximal colon. The primary outcome was the proportion of patients with at least one neoplastic lesion at baseline and after 2 years.. Neoplasia detection rates at baseline colonoscopy were 27% for WLE versus 30% for CE (odds ratio [OR], 1.23; 95% confidence interval [CI], 0.69-2.2; P = .56). In the proximal colon, neoplasia detection rates were 16% for WLE versus 24% for CE (OR, 1.6; 95% CI, 0.9-3.1; P = .13). Total procedure time was 9 minutes longer in the CE group. At follow-up after 2 years, neoplasia detection rates were similar in both groups: 26% for the original WLE group versus 28% for the CE group (OR, 1.1; P = .81).. CE in the proximal colon for LS surveillance was not superior to WLE with respect to the initial detection of neoplasia, and not associated with reduced neoplasia detection rates after 2 years. The value of CE remains to be established. (Clinical trial registration number: NCT00905710.).

Topics: Adenocarcinoma; Adenoma; Adult; Colonoscopy; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Netherlands; Watchful Waiting

A low adenoma detection rate (ADR) increases risks of interval cancers (ICs). Proximal colon flat polyps, e.g. serrated lesions (SLs), are difficult to find. Missed proximal colon flat lesions likely contribute to IC.. We compared chromoendoscopy with water exchange (CWE), water exchange (WE) and air insufflation (AI) in detecting adenomas in screening colonoscopy.. After split-dose preparation, 480 veterans were randomized to AI, WE and CWE.. Primary outcome of proximal ADR (55.6% vs 53.4% vs 52.2%, respectively) were similar in all groups. Adenoma per colonoscopy (APC) and adenoma per positive colonoscopy (APPC) were comparable. Detection rate of proximal colon SLs was significantly higher for CWE and WE than AI (26.3%, 23.6% and 11.3%, respectively,. When an endoscopist achieves high-quality AI examinations with overall ADR twice (61.6%) the recommended standard (30%), use of WE and CWE does not produce further improvement in proximal or overall ADR. Comparable APC and APPC confirm equivalent withdrawal inspection techniques. WE alone is sufficient to significantly improve detection of proximal SLs. The impact of increased detection of proximal SLs by WE on prevention of IC deserves to be studied. This study is registered at ClinicalTrial.gov (NCT#01607255).

Topics: Adenoma; Aged; Air; Colon; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Early Detection of Cancer; Female; Humans; Indigo Carmine; Insufflation; Intestinal Mucosa; Male; Mass Screening; Middle Aged; Prospective Studies; United States; United States Department of Veterans Affairs; Water

In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome.. We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected.. A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001).. The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.

Topics: Adenoma; Adult; Carcinoma; Colon; Colonoscopy; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; Coloring Agents; Early Detection of Cancer; Female; Humans; Indigo Carmine; Male; Middle Aged; Rectum; Single-Blind Method

Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study.. This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR.. A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79).. The study showed that EMR can be performed also in LVC.

Topics: Adenocarcinoma; Adenoma; Aged; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Gastrointestinal Hemorrhage; Humans; Indigo Carmine; Intestinal Mucosa; Intestinal Polyps; Italy; Lymphoma, B-Cell, Marginal Zone; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Hemorrhage; Prospective Studies; Surgicenters; Workload

Colonoscopy is the accepted gold standard for detecting colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. The aim of this study was to determine whether enhanced mucosal contrast using pancolonic chromoendoscopy (PCC) allows higher rates of adenoma detection.. In a prospective, randomised two-centre trial, PCC (with 0.4% indigo carmine spraying during continuous extubation) was compared with standard colonoscopy (control group) in consecutive patients attending for routine colonoscopy. The histopathology of the lesions detected was confirmed by evaluating the endoscopic resection or biopsy specimens.. A total of 1008 patients were included (496 in the PCC group, 512 in the control group). The patients' demographic characteristics and indications for colonoscopy were similar in the two groups. The proportion of patients with at least one adenoma was significantly higher in the PCC group (46.2%) than in the control group (36.3%; p = 0.002). Chromoendoscopy increased the overall detection rate for adenomas (0.95 vs 0.66 per patient), flat adenomas (0.56 vs 0.28 per patient) and serrated lesions (1.19 vs 0.49 per patient) (p < 0.001). There was a non-significant trend towards increased detection of advanced adenomas (103 vs 81; p = 0.067). Mean extubation times were slightly but significantly longer in the PCC group in comparison with the control group (11.6 ± 3.36 min vs 10.1 ± 2.03 min; p < 0.001).. Pancolonic chromoendoscopy markedly enhances adenoma detection rates in an average-risk population and is practicable enough for routine application.

Topics: Adenoma; Aged; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Prospective Studies

At present, all colonic polyps are removed and sent for histopathological evaluation, resulting in laboratory and reporting costs. Recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines have set standards for in-vivo diagnosis in place of conventional histopathology, and all future technologies will have to be tested against these standards. Data on flexible spectral imaging color enhancement (FICE) were very limited. This study aims to evaluate the accuracy of FICE and indigo carmine (IC) for in-vivo histology prediction for polyps of less than 10 mm in size and to assess the economic impact of this strategy.. In a screening population, polyps of less than 10 mm were assessed using white light (WLI) by FICE, by IC, and the predicted diagnosis was recorded. Polyps were then removed and sent for histological analysis. Accuracy of the predicted rescope interval was calculated using British Society of Gastroenterology and ASGE guidelines. Two models for using in-vivo diagnosis were proposed and savings in terms of histopathology costs calculated.. A total of 232 polyps of less than 10 mm were examined. FICE improved the accuracy of in-vivo diagnosis of adenoma to 88% compared with 75% with WLI (P<0.0001). IC after FICE improved this further to 94%. Rescope interval could be set correctly using FICE or IC in 97% of cases by British Society of Gastroenterology guidelines or 97% with FICE and 99% with IC using ASGE guidelines. A saving of £678,253 (€762767) per annum could be made within the UK national screening population.. FICE and IC significantly improves the in-vivo diagnosis of colonic polyps over WLI and can lead to significant cost savings.

Topics: Adenoma; Aged; Colonic Polyps; Colonoscopy; Coloring Agents; Cost-Benefit Analysis; Early Detection of Cancer; England; Epidemiologic Methods; Female; Health Care Costs; Humans; Image Interpretation, Computer-Assisted; Indigo Carmine; Male; Middle Aged; Population Surveillance

Magnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neoplastic lesions. This study aimed to compare the accuracy of virtual and real chromoendoscopy in differentiating neoplastic and non-neoplastic colorectal lesions.. A prospective randomized trial of magnification colonoscopy with targeted FICE (Group I - 72 patients/111 lesions) versus magnification colonoscopy with targeted indigo carmine dye (Group II - 72 patients/137 lesions) was performed in consecutive patients with lesions 1 cm or less. Histopathology of the specimens was regarded as the gold standard.. In group I, 86 (77.5%) lesions showed an intense vascular pattern (positive capillary meshwork), of which 80 (93%) were histologically confirmed as adenomas. From 25 lesions with negative capillary meshwork, 23 (92%) were non-neoplastic. Sensitivity, specificity, accuracy, positive and negative predictive values of the capillary meshwork for the differential diagnosis of these lesions was 97.8, 79.3, 92.8, 93 and 92%, respectively. The same parameters for pit pattern analysis by FICE were 92.7, 82.3, 90.1, 93.8 and 80%, respectively. Indigo carmine magnified chromoscopy showed sensitivity, specificity, accuracy, positive and negative predictive values of 97, 88.9, 94.9, 96.1 and 91.4%, respectively in the discrimination between neoplastic and non-neoplastic lesions.. Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.

Topics: Adenoma; Brazil; Chi-Square Distribution; Colonic Polyps; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Endoscopy, Gastrointestinal; Female; Humans; Image Enhancement; Indigo Carmine; Intestinal Polyps; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Rectum; Sensitivity and Specificity

Colonoscopy is the accepted gold standard for screening of neoplastic colorectal lesions, but the substantial miss rate remains a challenge. Computed virtual chromoendoscopy with the Fujinon intelligent colour enhancement (FICE) system is a new dyeless imaging technique that might allow higher rates of adenoma detection.. This is a prospective randomised five tertiary care centre trial of colonoscopy in the FICE mode versus standard colonoscopy with targeted indigocarmine chromoscopy (control group) in consecutive patients attending for routine colonoscopy. Histopathology of detected lesions was confirmed by evaluation of endoscopic resection or biopsy specimens.. 871 patients were enrolled, and 764 patients (344 female, mean age 64 years) were subjected to final analysis (368 in the FICE group, 396 in the control group). In total, 236 adenomas (mean of 0.64 per case) were detected in the FICE group and 271 adenomas (mean of 0.68 per case) in the control group (p = 0.92). There was no statistically significant difference in the percentage of patients with >or=1 adenoma between the control group (35.4%) and the FICE group (35.6%) (p = 1.0). For the differential diagnosis of adenomas and non-neoplastic polyps, the sensitivity of FICE (92.7%) was comparable with that of indigocarmine (90.4%) (p = 0.44).. At colonoscopy, adenoma detection rates are not improved by virtual chromoendoscopy with the FICE system compared with white light endoscopy with targeted indigocarmine spraying. However, FICE can effectively substitute for chromoscopy concerning the differentiation of neoplastic and non-neoplastic lesions.

Topics: Adenoma; Aged; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Indigo Carmine; Male; Middle Aged; Prospective Studies

It remains controversial whether chromocolonoscopy using indigocarmine increases the detection of colorectal polyps. We aimed to assess the impact of indigocarmine dye spray on the detection rate of adenomas and the feasibility of learning the technique in a Western practice.. 400 patients were prospectively allocated into 2 groups; A (n = 200): indigocarmine chromocolonoscopy was performed by a Japanese colonoscopist with expertise in chromoscopy; B (n = 200): initial 100 patients (B-1), a Western colonoscopist with no previous experience of chromoscopy performed conventional colonoscopy, but with at least 10 min observation during colonoscopy withdrawal. In the next 100 patients (B-2), he performed chromocolonoscopy. All polyps found were resected. Regression analysis was used to compare the numbers of polyps detected in groups A, B-1 and B-2, whilst controlling for gender, age, indication and history of colorectal cancer.. There were significant differences in the numbers of neoplastic polyps and flat adenomas between groups A and B-1 as well as between B-1 and B-2, but not between A and B-2. There was no significant difference in numbers of advanced lesions. Chromocolonoscopy (A and B-2) detected more neoplastic polyps of

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Colon; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Female; Humans; Indigo Carmine; Logistic Models; Male; Middle Aged; Prospective Studies

Previous data suggest that routine chromoendoscopy may increase detection rates of diminutive or flat lesions. The aim of this study was to evaluate the usefulness of chromoendoscopy in the ascending colon and cecum, where the incidence of diminutive or flat lesions is high.. Between June 2006 and September 2006, a total of 316 consecutive patients were prospectively enrolled in this study. The patients were randomly divided into two groups (control group: 158 patients, chromoendoscopy group: 158 patients). If the quality of bowel preparation was poor or cecal intubation was not achieved, the patient was excluded from the study. In the control group, the ascending colon and cecum were observed twice without chromoendoscopy. In the chromoendoscopy group, the cecum and ascending colon were reinspected following staining with indigocarmine solution after conventional examination of the cecum and ascending colon. Finally, a total of 151 and 149 patients were enrolled in the control and chromoendoscopy groups, respectively.. The chromoendoscopy group differed significantly from the control group in the number of additionally detected polyps (control: 14 versus chromoendoscopy: 62, p<0.001) and in the number of patients with additionally detected polyps (control: 12 versus chromoendoscopy: 50, p<0.001). Multivariate analysis revealed that detection of polyps after indigocarmine spraying was independently associated with a high body mass index and older age (p = 0.045 and p = 0.006, respectively).. With chromoendoscopy using indigocarmine, more polyps can be detected in the ascending colon and cecum as compared with using conventional colonoscopy.

Topics: Adenoma; Cecal Neoplasms; Cecum; Colon, Ascending; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged

High-resolution colonoscopy with chromoscopy (HRC) is a technique designed to improve the detection of colonic neoplasias. We prospectively compared standard colonoscopy (SC) and HRC in a randomized multicenter trial.. Patients (n = 203; age, 58 +/- 10 years; sex ratio, 1) were recruited according to the following criteria: (1) a history of either familial or personal colonic neoplasia or (2) alarm symptoms after the age of 60 years. After randomization, an SC was performed in 100 patients (resolution, < or = 410,000 pixels) and a HRC in 103 patients (Fujinon EC485ZW, 850,000 pixels). In the HRC group, each colonic segment was examined before and after spraying with indigo carmine 0.4%.. Two hundred seventy-six polyps were detected in 198 patients. One hundred sixty of them were hyperplastic polyps, 116 were adenomas, and 2 were carcinomas. The numbers of hyperplastic polyps and purely flat adenomas were significantly higher in the HRC group than in the SC group (1.1 +/- 1.6 vs 0.5 +/- 1.4 and 0.22 +/- 0.68 vs 0.07 +/- 0.29, respectively; P = .01 and P = .04), but there was no significant difference in the total number of adenomas per patient (primary end point) detected between the HRC and the SC groups (0.6 +/- 1.0 vs 0.5 +/- 0.9, respectively).. Although HRC improves detection of purely flat adenomas and hyperplastic polyps, the overall detection of colonic adenomas in a population at increased risk of neoplasia is not significantly improved. These findings do not support the routine use of HRC in clinical practice.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Carcinoma; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Female; France; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Prospective Studies

Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect.. We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect.. Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash.. A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8-41)) and chromoscopy (median 17 minutes (range 8-39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65-90)) and normal saline used in the control group (69 ml (range 60-93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p<0.05) with significantly more diminutive (<4 mm) adenomas detected in the pan-chromoscopy group (p = 0.03). Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls (p<0.05), with more patients with multiple adenomas (>3) detected using pan-chromoscopy (p<0.01). Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls (p<0.001). More hyperplastic polyps were detected in the left colon (86% rectosigmoid) using chromoscopy compared with controls.. Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions. Importantly, eight diminutive lesions had foci of high grade dysplasia. Chromoscopy may benefit patients, assuming a high risk of colorectal cancer, and help in risk stratification and planning follow up colonoscopy intervals.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Colon; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Disease Progression; Female; Humans; Hyperplasia; Indigo Carmine; Male; Middle Aged; Neoplasm Invasiveness; Precancerous Conditions

Small adenomas may be missed during colonoscopy, but chromoscopy has been reported to enhance detection. The aim of this randomized-controlled trial was to determine the effect of total colonic dye spray on adenoma detection during routine colonoscopy.. Consecutive outpatients undergoing routine colonoscopy were randomized to a dye-spray group (0.1% indigo carmine used to coat the entire colon during withdrawal from the cecum) or control group (no dye).. Two hundred fifty-nine patients were randomized, 124 to the dye-spray and 135 to the control group; demographics, indication for colonoscopy, and quality of the preparation were similar between the groups. Extubation from the cecum took a median of 9:05 minutes (range: 2:48-24:44 min) in the dye-spray group versus 4:52 minutes (range: 1:42-15:21 min) in the control group (p < 0.0001). The proportion of patients with at least 1 adenoma and the total number of adenomas were not different between groups. However, in the dye-spray group significantly more diminutive adenomas (<5 mm) were detected proximal to the sigmoid colon (p = 0.026) and more patients were identified with 3 or more adenomas (p = 0.002). More non-neoplastic polyps were detected throughout the colon in the dye-spray group (p = 0.003). There were no complications.. Dye-spray increases the detection of small adenomas in the proximal colon and patients with multiple adenomas, but long-term outcomes should be studied to determine the clinical value of these findings.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colon; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Feasibility Studies; Female; Humans; Indigo Carmine; Male; Middle Aged; Sensitivity and Specificity

Chromoendoscopy may reliably separate adenomatous from nonadenomatous polyps. The aim of this multicenter trial was to determine the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology.. This multicenter trial included 4 academic centers and a primary care practice. In 299 patients referred for routine colonoscopy or sigmoidoscopy, 520 polyps 10 mm in size were sprayed with indigo carmine dye. Using a high-resolution endoscope, the endoscopist predicted the histology of each polyp based on its surface characteristics. Hyperplastic polyps had a "pitted" surface pattern of orderly arranged "dots" that resembled surrounding normal mucosa. Adenomatous polyps had at least one surface "groove" or "sulcus." Each polyp was subsequently resected for histopathologic evaluation.. The resected polyps were comprised by 193 adenomas (37%), 225 hyperplastic polyps (43%), and 102 "other" types (20%). Forty polyps (7.7%) could not be classified by high resolution chromoendoscopy with indigo carmine dye. For the remaining polyps, the sensitivity, specificity, and negative predictive value of indigo carmine dye staining for adenomatous polyps were, respectively, 82%, 82%, and 88%. The results were consistent among the academic centers and the primary care practice.. High-resolution chromoendoscopy with indigo carmine dye demonstrates morphologic detail of diminutive colorectal polyps that can reliably be used to separate adenomatous from nonadenomatous polyps.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Colonic Polyps; Colonoscopy; Coloring Agents; Diagnosis, Differential; Female; Humans; Hyperplasia; Indigo Carmine; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Staining and Labeling

Based on 10 years of experience with chromoendoscopy, our hypothesis was that colonic adenomas can be differentiated from hyperplastic polyps by use of a high-pressure spray-jet of dye (pressure dye-spray). To test the accuracy of pressure dye-spray, classification of colonic polyps as adenomas and hyperplastic polyps by pressure dye-spray and ordinary colonoscopic findings (shape, size, and color surface appearance) were compared.. Pressure dye-spray chromoendoscopy was performed by using 0.035% indigo carmine, a spray-type cannula, and a water pump. Polyps were first classified as adenomas or hyperplastic polyps by ordinary colonoscopic findings. One or more pressure dye-spray bursts were then focused on the polyp from a distance of 1 to 2 cm. Polyps were classified as adenomas only if oozing of blood was evident; otherwise, they were classified as hyperplastic polyps. A histologic diagnosis was obtained for all polyps, and the results of ordinary colonoscopic findings and pressure dye-spray were compared.. This study examined 1468 polyps (1201 adenomas, 267 hyperplastic polyps; mean diameter 4 mm). The sensitivities for polyp differentiation with pressure dye-spray and ordinary colonoscopic findings were, respectively, 97.9% and 73.4% (p < 0.0001); specificities were, respectively, 96.6% and 92.1% (p = 0.077).. Pressure dye-spray was found to be a reliable technique for differentiation between adenomas and hyperplastic polyps.

Topics: Adenoma; Cohort Studies; Colonic Polyps; Colonoscopy; Coloring Agents; Diagnosis, Differential; Humans; Hyperplasia; Indigo Carmine; Pressure; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity

Sessile serrated lesions (SSLs) are precursors of colon cancer, especially in cases of large, right colon. However, they are difficult to not only detect, but only clarify the margin of the lesion, which can lead to the poor endoscopic treatment outcomes.. This study evaluated the usefulness of acetic acid spray with narrow-band imaging (A-NBI) for the better visualization of the margin of SSLs.. From January 2013 to March 2022, patients with superficial elevated polyps suspected of being SSLs ≥ 10 mm with an endoscopic diagnosis that had been endoscopically resected at Hiroshima City Hiroshima Citizens Hospital were enrolled. Endoscopic images with white-light imaging (WLI), narrow-band imaging (NBI), indigo-carmine (IC), and A-NBI were recorded in each lesion and were randomly arranged and assessed by 10 endoscopists. We compared the visibility score (1 to 4) and color differences (ΔE) between inside and outside of the lesions among WLI, NBI, IC, and A-NBI.. Forty-one lesions in 33 cases were included, and a total of 164 images were evaluated. As for the visibility score, most of the lesions were scored as 1 or 2 on WLI, whereas most were scored 4 on A-NBI. The median ΔE of A-NBI was also significantly higher than that of WLI, NBI, or IC (20.5 vs. 8.3 vs. 8.2 vs. 12.3, P < 0.01). A significant correlation was observed between the color difference and visibility score (r = 0.53, P < 0.01).. A-NBI may be a useful modality for identifying the margin of SSLs.

Topics: Acetic Acid; Adenoma; Colonic Neoplasms; Colonoscopy; Humans; Indigo Carmine; Narrow Band Imaging

Colonoscopy is currently considered the optimal method to detect colorectal neoplasia; however, some adenomas remain undetected. While indigo carmine staining with a dye-spray catheter has demonstrated promising results for reducing the miss rate, we investigated the oral indigo carmine method. The aim of this study was to determine whether oral indigo carmine intake before standard colonoscopy increases the adenoma (and adenocarcinoma) detection rate (ADR) or the mean number of adenomas per patient (MAP).. The oral indigo carmine method was performed from April 2018 to July 2020 in two hospitals. Data were collected in a prospective manner and compared to the conventional group whose data were collected retrospectively and consecutively from January 2016 to March 2018. All data were anonymized.. Among the 704 patients included, colonoscopies were completely performed in 693 patients (347 in the indigo group). The ADR did not significantly differ between the groups: 42.3% vs. 40.3% (indigo vs. conventional group; odds ratio: 1.13; 95% confidence interval: 0.9-1.33,. The routine use of oral indigo carmine does not lead to a higher ADR despite the higher MAP.

Topics: Adenoma; Cecum; Colon; Colonoscopy; Colorectal Neoplasms; Humans; Indigo Carmine; Prospective Studies; Retrospective Studies

Cap-assisted and chromo-colonoscopy are 2 techniques which may increase adenoma detection; however, chromo-colonoscopy is limited by increased time requirement. In this edition of The American Journal of Gastroenterology, Kim et al. present data from a randomized controlled trial comparing standard colonoscopy with an arm using both techniques (CAP/CHROMO). The indigo carmine was applied using a simpler method than previous studies, resulting in shorter times. The CAP/CHROMO adenoma detection was higher than the controls (54.4% vs 44.9%; P < 0.001), but there was no difference for advanced neoplasia. If endoscopists find these data convincing, they should trial these techniques separately because each technique may have a different impact.

Topics: Adenoma; Colonoscopy; Gastroenterology; Humans; Indigo Carmine

Topics: Acetic Acid; Adenoma; Colonic Polyps; Colorectal Neoplasms; Coloring Agents; Endoscopy; Humans; Indicators and Reagents; Indigo Carmine

Colorectal laterally spreading tumor granular type (LST-G) is generally divided into two subtypes based on morphology. Here, we retrospectively investigated the clinical significance of a concrete, objective LST-G subclassification.. This study examined 636 consecutive cases that were resected endoscopically or surgically. LST-G was subclassified as follows: Type 1, a lesion with homogenous uniform granules with uniform (<5 mm) nodules; Type 2, a lesion with granules and small nodules (≥5 mm, <10 mm); or Type 3, a lesion accompanied by large nodules (≥10 mm). For the validation study, 194 images were compiled from 97 cases investigated using conventional colonoscopy and chromoendoscopy with indigo carmine dye spraying. Images were distributed in a randomized order to students without prior endoscopy experience, less-experienced endoscopists (LEE group), and highly experienced endoscopists (HEE group). Diagnostic accuracy and interobserver agreement were then evaluated.. There was no submucosal invasion in Type 1 lesions. The incidence of deep submucosal invasive carcinoma was higher for Type 3 lesions than for Type 2 lesions. Interobserver agreement was good in each group. Diagnostic accuracy was higher in the HEE group than in the student and LEE groups. Chromoendoscopy had a higher accuracy rate than conventional colonoscopy in the LEE and HEE groups (LEE, 0.74 vs 0.69, P < 0.05; HEE, 0.84 vs 0.78, P < 0.05).. This subclassification of LST-G according to the diameters of granules and nodules was both useful for choosing therapeutic strategies in the clinical setting and universally applicable.

Topics: Adenocarcinoma; Adenoma; Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Cytoplasmic Granules; Female; Humans; Indigo Carmine; Japan; Male; Middle Aged; Neoplasm Invasiveness; Observer Variation; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Terminology as Topic

To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).. Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.. The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively. Preoperative diagnoses of carcinomas were made in 88% (57/65) of the carcinoma lesions via endoscopy or biopsy. Endoscopic findings associated with carcinoma were red color, depression, and mixed-type morphology.. Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Biopsy; Coloring Agents; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Hyperplasia; Indigo Carmine; Japan; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Video Recording

To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.. A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables.. En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC.. AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

Topics: Acetic Acid; Adenocarcinoma; Adenoma; Biopsy; Chi-Square Distribution; Coloring Agents; Early Detection of Cancer; Gastroscopy; Humans; Indigo Carmine; Japan; Logistic Models; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prospective Studies; Stomach Neoplasms

Cold biopsy forceps polypectomy (CBP) is commonly used for the removal of diminutive polyps; however, evidence for the efficacy of CBP is lacking. The aim of this study was to evaluate the adequacy of resection of diminutive polyps and to identify predictors for complete resection using CBP.. This was a prospective study from a tertiary referral hospital in Korea. A total of 196 patients were screened, and 65 patients with diminutive polyps were enrolled. CBP was used to resect diminutive polyps until no polyp was visible by chromoendoscopy using indigo carmine spray. Each polyp base was then resected using endoscopic mucosal resection (EMR) with a 1-3-mm free margin. CBP and EMR specimens were sent to the histopathology department for the evaluation of the completeness of the resection. Cross sections of the EMR specimens made at 1-mm intervals were examined by a pathologist.. A total of 86 diminutive polyps were available for assessment. Overall, 90.7% (78/86) of the diminutive polyps were completely resected using CBP (95%CI 84.6-96.8%). The complete resection rate for all diminutive adenomas was 92.3 % (60/65; 95%CI 85.8-98.8%) and for 1-3-mm adenomas 100% (95%CI 81.5-100%). Polyp size, histology, and location, and number of biopsies were not different between the complete and incomplete resection groups.. In this small study approximately 90 % of all diminutive polyps and 100% of 1-3-mm adenomatous polyps were completely resected using CBP and chromoendoscopy. CBP appears to be adequate for the resection of the majority of diminutive polyps, especially small sized adenomas (≤ 3 mm) if no residual tissue is visible by chromoendoscopy.

Topics: Adenoma; Adult; Aged; Biopsy; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Dissection; Female; Humans; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Neoplasm, Residual; Prospective Studies

The laterally spreading colon tumors (LST) constitute a kind of flat superficial neoplasia, which may cause colorectal cancer. There was studied the efficacy of colonoscopy and chromoscopy, using indigocarmine and acetic acid in the LST diagnosis in 897 patients. In 85 (9.5%) patients, suffering adenoma 113 LST were revealed, including 84 (74.3%) of a nongranular type (LST - NG), 29 (25.7%)--of granular type (LST - G). The diameter of LST was from 10 to 120 mm, 19.6 mm at average. Tubular adenoma was diagnosed in 67 (59%) observations, the dentate one--in 24 (21%), papillary--in 12 (11%), papillary-tubular--in 10 (9%).

Topics: Acetic Acid; Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colon; Colonic Neoplasms; Colonoscopy; Female; Histocytochemistry; Humans; Indigo Carmine; Male; Middle Aged; Tumor Burden; Video Recording

Endoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for tumor of the duodenal papilla. For complete resection, precise assessment of not only the intraductal extent but also the lateral margins of the tumor is mandatory before resection.. Our purpose was to prospectively assess the enhancement of the lateral margins of tumor of the duodenal papilla for the treatment of EP by comparing narrow-band imaging (NBI) and indigo carmine (IC) chromoendoscopy.. Prospective study.. This procedure was performed in Tokyo Medical University Hospital.. Fourteen consecutive cases of tumors of the major duodenal papilla.. All patients underwent EP after evaluation by NBI and IC.. Histologic evaluation of diagnosis of NBI and IC by comparison with en bloc tissue.. In all lesions, either IC or NBI were superior to conventional white-light imaging except in 1 IC case. The ability of NBI observation to emphasize the tumor margin was statistically significantly better than IC observation (P< .05). The en bloc EP was endoscopically successful in all cases, without fatal adverse events. En bloc tissue revealed 13 adenomas and 1 adenoma with focal adenocarcinoma. There was no residual adenoma in lateral margin specimens, either endoscopically or histologically.. The lesions resected were all relatively small. This was not a blinded randomized study.. This study demonstrated the feasibility and a certain degree of efficacy of NBI for enhancement of the tumor margin of duodenal papilla. Further blinded randomized studies involving large duodenal papillary tumors are required.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Biopsy, Needle; Cholangiopancreatography, Endoscopic Retrograde; Diagnostic Imaging; Duodenal Neoplasms; Duodenoscopy; Endosonography; Female; Humans; Image Enhancement; Immunohistochemistry; Indigo Carmine; Male; Middle Aged; Preoperative Care; Prospective Studies; Sensitivity and Specificity; Video Recording

Individuals carrying germline mutations in one of the genes responsible for hereditary nonpolyposis colon cancer (HNPCC) have a lifetime risk of up to 80 % of developing colorectal cancer. As there is evidence for a higher incidence of flat adenomatous precursors and because an accelerated adenoma-carcinoma sequence has been postulated for these patients, early detection of these lesions is essential. It was the aim of the present study to assess the detection rate of polypoid lesions by comparing chromocolonoscopy with standard white light colonoscopy and narrow-band imaging (NBI) colonoscopy.. 109 patients were included (98 with a functionally relevant mutation in a mismatch repair gene, 11 fulfilling the strict Amsterdam criteria). In 47 patients, standard colonoscopy was followed by chromocolonoscopy with indigo carmine. In 62 patients, NBI was performed first followed by chromocolonoscopy.. A total of 128 hyperplastic and 52 adenomatous lesions were detected. In the first series, 0.5 lesions/patient were identified by standard colonoscopy and 1.5 lesions/patient by chromocolonoscopy ( P < 0.001). In the second series, 0.7 lesions/patient were detected by NBI colonoscopy and 1.8 lesions/patient by chromocolonoscopy ( P = 0.01). At least one adenoma was detected in 15 % of patients by both standard and NBI colonoscopy compared with 28 % of patients by chromocolonoscopy.. According to this study, chromocolonoscopy detects significantly more hyperplastic and, in particular, adenomatous lesions than standard white light colonoscopy or NBI.

Topics: Adenoma; Adult; Base Pair Mismatch; Colon; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis; Coloring Agents; Diagnosis, Differential; Early Detection of Cancer; Germ-Line Mutation; Humans; Hyperplasia; Indigo Carmine; Mass Screening; Middle Aged; Precancerous Conditions

Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % - 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of high resolution endoscopy (HRE) and the additional value of chromoendoscopy in the evaluation of duodenal polyposis in FAP.. 43 FAP patients scheduled for surveillance endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining.. Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining ( P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas.. HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. Chromoendoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoendoscopy with side-viewing endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.

Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Aged; Duodenal Neoplasms; Duodenoscopy; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Neoplasm Staging; Sensitivity and Specificity; Staining and Labeling; Young Adult

Conventional endoscopy and chromoendoscopy with indigo carmine dye are usually performed for recognizing adequate tumor-negative lateral margins for successful endoscopic resection of gastric neoplasia. However, chromoendoscopy with indigo carmine dye added to acetic acid has not been used for this purpose.. Our purpose was to compare the diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid with that of conventional endoscopy and chromoendoscopy with indigo carmine dye or acetic acid alone.. Prospective study.. Social Insurance Funabashi Central Hospital.. Forty-seven consecutive patients (53 lesions) with early gastric cancer and gastric adenomas who underwent endoscopic submucosal dissection (ESD) from April 2006 to July 2007 were studied.. All the lesions were examined by the endoscopic modalities before ESD, and the resected specimens were analyzed histopathologically.. Two endoscopists independently evaluated the diagnostic performance of each image in terms of recognition of tumor borders with reference to macroscopic and histopathologic findings of resected specimens. We also conducted a substudy to assess interobserver variability.. There was good interobserver agreement between the 2 endoscopists in this study (kappa index = 0.764). The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was significantly greater than that of any of the other modalities (vs each: P < .005).. The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was better compared with conventional endoscopy and chromoendoscopy by using only indigo carmine dye or acetic acid. The applicability of this method for gastric neoplasia merits further investigation.

Topics: Acetic Acid; Adenoma; Adult; Aged; Aged, 80 and over; Endoscopy; Female; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Observer Variation; Prospective Studies; Stomach Neoplasms

Discrimination between neoplastic and non-neoplastic lesions is crucial in colorectal cancer screening. Application of narrow-band imaging (NBI) in colonoscopy visualises mucosal vascular networks in neoplastic lesions and may improve diagnostic accuracy.. To compare the diagnostic efficacy of NBI in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of standard modalities, conventional colonoscopy, and chromoendoscopy.. In this prospective study, 180 colorectal lesions from 133 patients were observed with conventional colonoscopy, and under low-magnification and high-magnification NBI and chromoendoscopy. Lesions were resected for histopathological analysis. Endoscopic images were stored electronically and randomly allocated to two readers for evaluation. Sensitivity, specificity and diagnostic accuracy of each endoscopic modality were assessed by reference to histopathology.. NBI and chromoendoscopy scored better under high magnification than under low magnification in comparison with conventional colonoscopy. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (low magnification: p = 0.0434 for reader 1 and p = 0.004 for reader 2; high magnification: p<0.001 for both readers) and was comparable to that of chromoendoscopy.. Both low-magnification and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions; the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. The role of NBI in screening colonoscopy needs further evaluation.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Epidemiologic Methods; Female; Humans; Image Processing, Computer-Assisted; Indigo Carmine; Male; Middle Aged

Topics: Adenoma; Clinical Competence; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Humans; Indigo Carmine; Predictive Value of Tests

The aim of our study was to determine whether chromoendoscopy with indigo carmine significantly improves the detection of adenomas in the distal colon and rectum and therefore could become routine in flexible sigmoidoscopy screening.. Between 2001- 2003, two sigmoidoscopies, the first conventional, the second with chromoendoscopy, were performed in a "back-to-back" design by two experienced endoscopists in a series of 55 patients. All lesions were classified with regard to position and size before and after staining, then endoscopically removed and referred to two experienced pathologists.. 55 patients, mean age 60 +/- 9.8 (42-79) years, 34 (61.8%) men and 21 (38.2%) women were enrolled. After staining, 47 patients had 373 visible lesions, 306 (82%) < 3mm, 47 (12.6%) 3- 5 mm and 20 (5.4%) > 5 mm. Histologically, 215 (57.7%) were hyperplastic polyps, 27 (7.2%) adenomas and 131 (35.1%) other lesions. With chromoendoscopy, in 17 of the 47 patients (36.2%) 27 adenomas (15 5 mm) were detected. Chromoendoscopy significantly improved the detection of adenomas

Topics: Adenoma; Adult; Aged; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Sigmoidoscopy

The aim of this study was to determine the detection rate of polyps using zoom chromoendoscopy (ZE) compared with standard video colonoscopy.. End-to-end colonoscopies were performed in 50 patients by two different endoscopists blinded for each other's results. Lesions detected during initial standard colonoscopy (C1) were biopsied or removed by snare resection. The second colonoscopy (C2) was done with a zoom colonoscope spraying the whole colon with indigocarmine (0.4%). In addition, detected mucosal lesions were documented prior to ZE and then classified according to the pit pattern classification before biopsy or removal. The retrieval time for each procedure was determined.. The average retrieval time for C1 was 13+/-9 min (9-24) and 28+/-11 min (16-38, p<0.05) for ZE. During C1, 56 lesions were detected in 26 of 50 patients (34 hyperplastic and 22 adenomatous). During C2, 19 additional polyps were documented prior to ZE (15% tandem miss rate), and 20 further lesions were detected with ZE (21% additional polyp detection rate compared to C1 and C2 without ZE). Of the 39 additional lesions removed during C2 after ZE, 29 were hyperplastic and 10 were adenomatous. Most adenomas detected during the second investigation were found in patients in whom adenomatous polyps had already been removed during the initial colonoscopy (9 of 26 patients vs 1 of 24 patients, p<0.02). No carcinoma was detected. The pit pattern classification allowed a correct differentiation between hyperplastic and adenomatous polyps (accuracy 93%, sensitivity 90%, specificity 97%).. Using zoom chromoendoscopy, the rate of detecting colonic polyps can be increased at the cost of a longer retrieval time.

Topics: Adenoma; Adolescent; Adult; Aged; Biopsy; Colonic Neoplasms; Colonoscopy; Coloring Agents; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Indigo Carmine; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Video Recording

Topics: Adenoma; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Endoscopy, Gastrointestinal; Humans; Indigo Carmine; Sensitivity and Specificity; Sigmoid Neoplasms

The ability to differentiate adenomatous from nonadenomatous colonic polyps by using chromoendoscopy would obviate the need to remove hyperplastic lesions. The aim of this study was to define the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology.. In 158 patients, 273 polyps (<5 mm) in the rectosigmoid were estimated for their histology. The endoscopists, in two steps, predicted the histopathology of each lesion on the basis of its surface characteristics by using high-resolution colonoscope without any staining and after indigo carmine dye according to the Kudo classification.. The resected polyps included 48 adenomatous and 225 nonadenomatous polyps. When histologically confirmed hyperplastic polyps were compared with adenomatous polyps, the prediction of hyperplastic polyps based on endoscopic findings had a sensitivity of 93%, a specificity of 60%, and an overall accuracy of 81%. The corresponding sensitivity, specificity, and overall accuracy after indigo carmine dye were 94%, 64%, and 83%, respectively.. The results suggest that the chromoendoscopy only marginally improves the determination between hyperplastic and adenomatous polyps when using high-resolution colonoscopes. The overall accuracy rate increased after dyeing, from 81% to 83%. The omission of histopathologic analysis cannot yet be achieved by chromoendoscopy.

Topics: Adenoma; Aged; Aged, 80 and over; Colonic Neoplasms; Colonic Polyps; Colonoscopes; Colonoscopy; Color; Coloring Agents; Endoscopy, Gastrointestinal; Female; Humans; Hyperplasia; Indigo Carmine; Male; Middle Aged; Predictive Value of Tests; Sigmoid Neoplasms

Colorectal cancer mortality is decreased by endoscopic polypectomy, but conventional colonoscopy may be inadequate for detecting subtle colonic lesions.. We selectively performed chromoendoscopy in all patients undergoing colonoscopy between January 1999 and December 2005 at the International Health Union of Rome. Patients with a history of colorectal polyps, inflammatory bowel disease, colorectal surgery or coagulopathy and those with poor bowel preparation were excluded from this analysis. Whenever colonoscopy revealed suspicious mucosal areas, dye-spraying with 0.2% indigo carmine solution was also performed. Findings from conventional and dyespraying views were classified morphologically, and specimens were analyzed histologically. Non-adenomatous lesions were classified as negative findings.. A total of 2005 patients underwent conventional colonoscopy and in 305 cases (15%) chromoendoscopy was also performed. Conventional colonoscopy identified 508 neoplasms in 381 patients (19%). Selective chromoendoscopy found an additional 244 neoplasms in 212 patients (11%). Thus, chromoendoscopy was positive in 212 (70%) of 305 patients in whom the examination was performed. Overall, 56 large, ulcerated, advanced cancers and 696 non-advanced neoplasms were found. Of the 696 nonadvanced neoplasms, 448 (65%) were polypoid and 248 (35%) were non-polypoid. All but 4 non-polypoid lesions were only detected with chromoendoscopy. Of the 248 non-polypoid lesions, 12 (5%) were depressed and 236 (95%) were flat. Advanced histology was present in 39 non-polypoid lesions (15%) and was more common in depressed lesions than in flat ones (58% vs. 13%; p<0.001).. Our study confirms the existence of flat and depressed neoplasms in an Italian population. The vast majority of non-polypoid lesions were only detected by chromoendoscopy, and many lesions with advanced histology were missed by conventional colonoscopy. We therefore recommend selectively performing chromoendoscopy when conventional colonoscopy provides clues for non-polypoid lesions. Therefore, endoscopists should be trained in the detection of these subtle mucosal clues, as well as in the use of chromoendoscopy to enhance their detection.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colonic Neoplasms; Colonoscopy; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Retrospective Studies

Aberrant crypt foci may represent preneoplastic lesions in the human colon. The prevalence of aberrant crypt foci detected using magnification chromoscopic colonoscopy is known to follow a stepwise progression from normal subjects to those with exophytic adenomas and colon cancer. No studies have addressed the prevalence of rectal aberrant crypt foci in patients with flat and depressed colonic lesions that cluster within the right hemi-colon and may undergo de novo neoplastic transformation.. All patients underwent total colonoscopy by a single endoscopist using the Olympus CF240Z magnifying colonoscope. Flat and depressed lesions were diagnosed using targeted indigo carmine chromoscopy. Prior to extubation, pan high-magnification-chromoscopy using indigo carmine was applied to the rectum and the distal 10 cm of mucosa examined using forward and retroflexed views. Aberrant crypt foci were defined as two or more crypts with dilated or slit-like openings that were raised above the adjacent mucosa. Using high-magnification chromoscopic colonoscopy we assessed the prevalence and dysplastic features of aberrant crypt foci in three groups: endoscopically "normal" subjects, patients with flat/depressed adenoma, and flat/depressed cancer.. Two thousand five hundred and fifty-nine patients underwent colonoscopy of which 1,000 were eligible for inclusion. The median number of aberrant crypt foci per patient in the endoscopically normal, adenoma, and cancer group was 1 (range: 0-5), 9 (range: 0-22), and 38 (range: 14-64), respectively. The estimated relative risk of dysplastic aberrant crypt foci when comparing the flat adenoma group with the endoscopically "normal" group was 4.68 (95% CI: 2.23-9.91) with the relative risk for flat cancer versus endoscopically normal group being 21.8 (95% CI: 10.9-23.8). Patients with >5 flat adenomas had higher crypt foci densities than those with <5 adenomas (r=0.53; p<0.001).. The number of aberrant crypt foci in normal patients, patients with flat adenoma, and flat cancer follow a stepwise incremental change as previously observed for exophytic adenomas and cancer. Detection of aberrant crypt foci in the rectum may be a useful biomarker for proximal colonic flat neoplasia and could be used at index flexible sigmoidoscopic screening to stratify risk of proximal colonic neoplasia. Patients with dysplastic aberrant crypt foci of high density should receive total colonoscopy.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colon; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Disease Progression; Female; Humans; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Precancerous Conditions; Prevalence; Prospective Studies; Rectum; Risk Factors; Sensitivity and Specificity

EMR is used to treat flat and sessile lesions in the colon. The aim of this study was to prospectively assess the efficacy of high-magnification chromoscopic colonoscopy in predicting complete resection margins after EMR.. A total of 1250 patients underwent colonoscopy by using a magnifying colonoscope. Chromoscopy with indigo carmine and crystal violet dye solutions was used to assess mucosal pit patterns. EMR was performed by using the saline solution inject-and-cut technique. After EMR, resection margins were inspected by using high magnification, and completeness of excision was predicted from the surface pit pattern. This was compared with completeness of excision as determined histopathologically.. A total of 684 lesions were treated by EMR (62 piecemeal) in 602 patients. The sensitivity of high-magnification chromoscopic colonoscopy for predicting remnant tissue in the lateral margins and the deep margins were, respectively, 79% and 80%. Specificity for both margins was 97%. The overall accuracy of high-magnification chromoscopic colonoscopy in predicting incomplete resection after EMR in the lateral axis and the deep axis was, respectively, 93% and 95%, where the true respective fractions of incomplete resections were 17% and 10%. Of the single en bloc EMRs performed, 77 (12%) had histopathologic evidence of incomplete resection in either axis, compared with 60 (97%) of the 62 piecemeal resections. Piecemeal resection was more likely to result in incomplete resection compared with en bloc EMR (p < 0.001). Complete resection by EMR was more likely if the lesion was sessile instead of flat (p < 0.001).. High-magnification chromoscopic colonoscopy as an in vivo modality for prediction of remnant tissue after EMR has a high overall accuracy, but further studies assessing long-term outcome and cost-effectiveness compared with conventional colonoscopic techniques are required.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Gentian Violet; Humans; Image Processing, Computer-Assisted; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Prospective Studies

This study describes the feasibility of magnifying colonoscopy with indigo carmine dye contrast to distinguish neoplastic and nonneoplastic colonic polyps. This study sampled consecutive patients undergoing colonoscopy using an Olympus CF240ZI from January to October 2000 at Chang-Gung Memorial Hospital, Lin-Kou Medical Center. This study analyzed a total of 270 polyps. Indigo carmine (0.2%) was sprayed directly on the mucosa surface before observing the crypts using a magnifying colonoscope (1.5x-100x). The pit patterns were described using the classification proposed by Kudo. Finally, polypectomy or biopsy was performed for histological diagnosis. The study identified 155 adenomas, 99 hyperplastic polyps, 9 adenocarcinomas, and 7 other nonneoplastic lesions (harmatoma, inflammatory polyps, and mucosal tag). The pit pattern was analyzed for all lesions. Further classification into neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic and others) polyps revealed 156 neoplastic and 14 nonneoplastic polyps among the type III to type V pits and 92 nonneoplastic and 8 neoplastic polyps among the type I and II pits. The sensitivity of type III to type V pits in detecting neoplastic polyps was 95.1%, with a specificity of 86.8% and diagnostic accuracy of 91.9%. The positive likelihood ratio was 7.3, and the negative likelihood ratio was 0.06. Magnifying colonoscopy with indigo carmine dye contrast provides morphological detail that correlates well with polyp histology. Small flat lesions with typical type II pit pattern should have minimal neoplastic risk, thus endoscopic resection is not necessary.

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Diagnosis, Differential; Drug Combinations; Female; Ferrous Compounds; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Mucins

Topics: Adenoma; Aged; Colonoscopy; Coloring Agents; Female; Humans; Ileal Neoplasms; Ileum; Indigo Carmine

The development of magnifying chromoendoscopy has facilitated the observation of mucosal pit patterns. This study investigated the value of this technology in predicting the histologic findings of colorectal lesions.. A total of 954 colorectal polyps were included. After identifying the lesions at colonoscopy, 0.2% indigocarmine solution was sprayed and then the zoom apparatus was switched to make a magnified view of the stained crypt orifice at a maximum 100 times magnification. The observed pit patterns were classified into 6 categories (I, II, IIIL, IIIS, IV, and V) according to Kudo's classification. Type I and II were designated as non-neoplastic patterns whereas other types were neoplastic. Correlation of the pit pattern with the findings of histologic examinations of resected or biopsied polyps was performed.. There were 678 diminutive (

Topics: Adenoma; Carcinoma; Clinical Competence; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Humans; Indigo Carmine; Prospective Studies; Sensitivity and Specificity

Nonpolypoid adenomas, which can be important precursors of colorectal cancers, are difficult to find during routine colonoscopy. The aim of this study was to evaluate the usefulness of routine chromoendoscopy in Korea, where the incidence of colorectal cancer is low compared with western countries.. Colonoscopy with chromoendoscopy was performed in 74 consecutive patients (48 men, 26 women; mean age 53.0 yr). After a careful examination of the whole colon, a defined segment of the sigmoid colon and rectum (0-30 cm from the anal verge) was stained with 20 ml of 0.2% indigocarmine solution with a spraying catheter. Nonpolypoid lesions were classified as flat or depressed types. Biopsies were taken from all lesions detected before or after staining with indigocarmine.. Indications for colonoscopy included routine check-up (21 patients), diarrhea or loose stool (14 patients), abdominal pain (12 patients), constipation (7 patients), bleeding (6 patients), and others (14 patients). Before staining, 58 lesions were found in 30 patients (43.2%). Histology showed tubular adenoma in 41 lesions, hyperplastic or inflammatory changes in 14 lesions, adenocarcinoma in 2 lesions, and villous adenoma in 1 lesion. After indigocarmine staining for normal-looking distal 30 cm colorectal mucosa, 176 lesions were found in 46 patients (62.2%). Histologically, 158 lesions were hyperplastic or inflammatory in nature, and 17 lesions (from 11 patients) were tubular adenomas. There was one serrated adenoma. Eighteen adenomas seen only after spraying indigocarmine were 2.6 +/- 0.6 mm in diameter, and all of them were classified as flat adenomas. There was no depressed-type adenoma. No adenoma with high grade dysplasia, villous histology, or cancer was found after staining. Presence of macroscopic adenomatous lesions or carcinoma before staining could not predict the existence of adenoma after staining.. In a large proportion of patients, flat or depressed adenomas could be found after spraying indigocarmine for normal-looking colorectal mucosa in Korea. The clinical significance of these diminutive adenomas that can be found only after spraying contrast agent needs to be further investigated.

Topics: Adenoma; Adult; Aged; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged

Topics: Adenoma; Colonic Polyps; Colonoscopy; Coloring Agents; Humans; Indigo Carmine

Circumferential mucosal incision around a lesion is effective for reliable endoscopic mucosal resection. However, mucosal incision with a needle knife is difficult, even with submucosal injection of normal saline solution. To make needle-knife incision easier and safer, sodium hyaluronate has been used rather than normal saline solution. The aim of this study was to evaluate the clinical outcome of endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.. For 70 gastric lesions treated by submucosal injection of sodium hyaluronate, the size of the lesion and the resection specimen, the en bloc resection rate, complications, and local recurrence during follow-up were assessed.. The mean size of the lesions and resection specimens were, respectively, 19.9 mm and 30.0 mm. The en bloc resection rates were 89% (42/47) for lesions up to 20 mm in diameter and 48% (11/23) for those greater than 20 mm (1-20 mm vs. >20 mm, p = 0.0004). Three patients underwent surgery because of invasive cancer in the EMR specimen. During follow-up (median 14 months, range 3-38 months), 2 recurrent lesions were found. No major complication occurred.. Submucosal injection of sodium hyaluronate is a reliable method with a high success rate for en bloc resection of lesions up to 20 mm in diameter. Mucosal incision with a needle knife can be performed safely with submucosal injection of sodium hyaluronate.

Topics: Adenocarcinoma; Adenoma; Adjuvants, Immunologic; Aged; Aged, 80 and over; Female; Gastric Mucosa; Gastroscopy; Humans; Hyaluronic Acid; Indigo Carmine; Injections; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Prospective Studies; Safety; Staining and Labeling; Stomach Neoplasms; Treatment Outcome

Flat and depressed cancers of the colon have now been recognized in several centers throughout the world. We report here a case of a 0.8-mm depressed adenoma with high-grade dysplasia in a 70-year-old man. We believe this to be the smallest adenoma ever reported, and unusually (for a small lesion) it was positive for the K-ras mutation.

Topics: Adenoma; Aged; Colonic Neoplasms; Colonoscopy; Genes, ras; Humans; Indigo Carmine; Indoles; Male; Mutation

Depressed early cancers and flat adenomas have a high potential for malignancy with possible infiltrating growth, despite the small size of the lesion. Japanese investigators have shown that early diagnosis and classification of these lesions is possible with the help of chromoendoscopy. The aim of this study, therefore, was to evaluate the usefulness of chromoendoscopy during routine colonoscopy.. During routine colonoscopy, vital staining with indigocarmine solution (0.4 %, 1 - 10 ml) was performed on all visible lesions in 100 consecutive patients without visible inflammatory changes. If findings on macroscopic examination were unremarkable, the sigmoid colon and rectum were stained with indigocarmine over a defined segment (0 - 30 cm ab ano) and inspected for lesions visible only after staining. Each lesion was classified with regard to type (polypoid, flat, or depressed), position and size. The staining pattern was classified according to the pit pattern classification.. A total of 52 patients had 105 visible lesions (89 polypoid, 14 flat and two depressed). The mean size of the lesions was 1.4 cm. Among the 48 patients with mucosa of normal appearance, 27 showed 178 lesions after staining (176 flat, two depressed) with a mean size of 3 mm. On histological investigation, 210 lesions showed hyperplastic or inflammatory changes, 67 were adenomas and six were cancers. Use of the pit pattern system to classify lesions (adenomatous, pit patterns III-V; nonadenomatous, pit patterns I-II) was possible, with a sensitivity of 92 % and a specificity of 93 %. Lesions with pit patterns III - V showed higher rates of dysplasia.. Chromoendoscopy allows easy detection of mucosal lesions in the colon and facilitates visualization of the margins of flat lesions. This technique unmasks multiple mucosal lesions which are not identified by routine video colonoscopy. The pit pattern seen after staining allows differentiation between hyperplastic and adenomatous lesions which may have consequences with regard to the endoscopic interventions needed.

Topics: Adenoma; Adult; Aged; Colon; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Sensitivity and Specificity; Staining and Labeling

Microadenomas or aberrant crypt foci (ACFs) are regarded as early neoplastic lesions that precede the development of macroscopic adenomas. The aim of this study was to characterize surface features of ileal microadenomas in patients with familial adenomatous polyposis (FAP). Magnifying ileoscopy was performed in 19 patients with FAP. A histologically verified adenomatous tubule, the existence of which was suggested by magnified observation, was regarded as a microadenoma. Magnifying ileoscopy detected microadenoma in five patients. In four of the five cases, the ileal microadenomas were identified as areas with tiny crypt openings or serrated surfaces, which were distinctive of nonneoplastic, diminutive protrusions. Magnifying ileoscopy seems to be useful in the detection of ileal microadenomas.

Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Aged; Biopsy; Colectomy; Colonoscopes; Coloring Agents; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Humans; Ileal Neoplasms; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Population Surveillance; Precancerous Conditions; Rectal Neoplasms; Stomach Neoplasms

Thirty-seven diminutive flat depressed neoplastic lesions of the colon, smaller than 5 mm, were detected by contrast chromoscopy using an indigo carmine capsule and subsequently removed by endoscopic mucosal resection. We investigated the endoscopic, macroscopic, and histologic characteristics of these lesions and also evaluated the usefulness of chromoscopy and the magnifying endoscope for detecting this type of lesion. The lesions were classified into two types according to the measured height of the histologic sections: 28 lesions were truly flat depressed and the remaining 9 lesions were flat elevated. Of the 37 lesions, 18 were adenomas with mild atypia, 14 with moderate atypia, and 5 with severe atypia. The flat depressed lesions included 12 with mild atypia, 11 with moderate atypia, and 5 with severe atypia. No invasive carcinoma was present in either type, and no adenoma with severe atypia was identified in any of the flat elevated lesions. The overall rate of severe atypia was 13.5%; the rate of severe atypia for the flat depressed type was 17.9%, which is approximately 14-fold greater than that of ordinary diminutive polypoid adenomas (1.3%). The detection of these lesions was facilitated by the use of indigo carmine dye, which clearly demonstrated the mucosal irregularities. The frequency of detection of these lesions was increased four to five times with a magnifying endoscope, as occurred in nearly 10% of all of the patients examined. These data suggest that the finding of endoscopically minute flat depressed neoplastic lesions is not at all uncommon when examination is meticulously performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenoma; Adenomatous Polyps; Adult; Aged; Colonic Neoplasms; Colonoscopy; Color; Female; Humans; Indigo Carmine; Male; Middle Aged

Topics: Adenoma; Animals; Blood Cell Count; Body Weight; Diet; Female; Indigo Carmine; Indoles; Lung Neoplasms; Male; Mice; Organ Size; Time Factors