indigo-carmine and Colonic-Diseases

Endoscopic submucosal dissection (ESD), a new widely accepted method for treating early gastric cancer, was developed to increase the en bloc rate, especially for lesions larger than 20 mm in diameter. This study aimed to evaluate the efficacy and safety of ESD for colorectal epithelial neoplasms.. From July 2006 to December 2007, ESD was indicated for patients with colorectal epithelial neoplasms larger than 20 mm in diameter. The rates of curative en bloc resection, the procedure time, and the incidence of complications were investigated.. A total of 74 colorectal epithelial neoplasms were resected by ESD. The mean diameter of these lesions was 32.6 mm (range, 20-85 mm). The rate of en bloc resection was 93.2% (69/74), and the mean ESD procedure time was 110 min (range, 80-185 min). None of patients had massive hemorrhage during ESD, and only one patient (1.4%) bled 8 days after ESD. Six patients experienced perforation, and all except one recovered after several days of conservative treatment. The patient who did not recover underwent urgent surgery. The perforation rate was 8.1% (6/74). All the patients were followed up. Healing of the artificial ulcer was confirmed, and with no lesion residue or recurrence was found.. The findings show ESD to be effective for colorectal epithelial neoplasm, making it possible to resect the whole lesion in one piece and to provide precise histologic information.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Colonic Diseases; Colorectal Neoplasms; Coloring Agents; Dissection; Endoscopy; Female; Follow-Up Studies; Humans; Indigo Carmine; Intestinal Mucosa; Intestinal Perforation; Intraoperative Complications; Male; Middle Aged; Young Adult

Blue dyes such as indigo carmine have become a frequent component of the submucosal injectate for EMR. Confirmation of the correct resection plane and assessment of the resection defect are facilitated by the selective staining of the submucosal layer. Nonstained areas are more difficult to evaluate and may contain inadvertent muscularis propria (MP) injury. The use of topical submucosal chromoendoscopy (TSC) may allow rapid and accurate assessment of these unstained areas and visual recognition of MP injury.. To evaluate the utility of a novel technique in the assessment of nonstained areas within the post-EMR defect.. Single-center prospective cohort study.. Academic, tertiary care referral center.. A total of 143 patients undergoing wide-field colonic EMR for sessile lesions 20 mm or larger.. A standard inject-and-resect EMR technique was applied with indigo carmine blue dye in the injectate. Defects with areas of nonstaining were recorded and examined, and then irrigated with the submucosal injectate by using the blunt tip of the injection catheter.. Detection of additional cases of MP injury by using TSC.. A total of 147 EMRs were performed. Focal areas of defect nonstaining were seen in 25 of cases (17%), with no MP injury identified on initial examination. After TSC, 2 additional cases of MP injury were identified, and these were successfully managed endoscopically. Intraprocedural recognition of deep resection increased from 4 cases (2.8%) to 6 cases (4.1%), thereby avoiding potential delayed perforation in 2 patients.. Single-center, nonrandomized study.. TSC is simple and effective and rapidly confirms the plane of resection and may improve detection of intraprocedural perforation.

Topics: Cohort Studies; Colon; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Coloring Agents; Humans; Indigo Carmine; Intestinal Mucosa; Prospective Studies

Topics: Colonic Diseases; Colonoscopy; Coloring Agents; Humans; Indigo Carmine; Infusion Pumps; Population Surveillance; Staining and Labeling