indigo-carmine and Hyperplasia

The risk of colon cancer is greater in patients with inflammatory bowel disease (IBD) than in the general population. Chromoendoscopy with dye (CE) is the currently recommended method for detecting dysplasia in screening colonoscopies in IBD patients; however, the role of virtual chromoendoscopy (VC) is not yet well defined.. The object of this study was to compare CE and VC with the iSCAN 1 system in the detection of neoplastic lesions in IBD patients.. We conducted a prospective, single-center, randomized study in IBD patients who underwent a colonoscopy for colon cancer screening. A total of 129 patients were included and were randomized to undergo a CE (n = 67) or a VC (n = 62). The rates of detection of neoplastic lesions by the 2 endoscopic techniques were compared.. A total of 19 neoplastic lesions (9 adenomas and 10 low-grade dysplasias [LGD]) was detected in 16 patients, 12 lesions in the CE group (17.9%), and 7 lesions in the VC group (11.3%; P = 0.2); no differences were found in the overall rate of detection of lesions (neoplastic or nonneoplastic; P = 1). The median of the total examination time and endoscope withdrawal time (minutes) was significantly lower in the VC group than in the CE group (15 vs 20 and 10 vs 14, respectively; P < 0.001).. No differences occurred in the rate of detection of neoplastic lesions between CE and VC with iSCAN 1. The time spent on the technique with VC is significantly less than that with CE.

Topics: Colonic Neoplasms; Colonoscopy; Coloring Agents; Humans; Hyperplasia; Indigo Carmine; Inflammatory Bowel Diseases; Prospective Studies

The accuracy of conventional colonoscopy to differentiate neoplastic and non-neoplastic polyps is limited, justifying a biopsy for histologic analysis. Magnifying chromocolonoscopy has emerged as the best tool available for differentiating adenomatous and hyperplastic polyps during colonoscopy; however, magnifying endoscopes are rarely used in endoscopy units. This study aimed to further validate the effectiveness of magnifying chromocolonoscopy in the diagnosis of neoplastic colorectal polyps in a screening center.. Five hundred average-risk subjects were randomly divided into two groups: a magnifying chromocolonoscopy group and a conventional chromocolonoscopy group, each of 250 subjects. Lesions were analyzed according to Kudo's classification of pit pattern (types I-V) and additionally subdivided into non-neoplastic (types I-II) and neoplastic (types III-V). Lesions judged as neoplastic were resected and those judged as non-neoplastic were left in situ. Only lesions < or =10 mm were included in the study. Resected lesions were analyzed with histopathological examination.. The overall accuracy of magnifying chromocolonoscopy for differentiating neoplastic lesions (95%, 135 of 142), was significantly higher than that of conventional chromocolonoscopy (84%, 102 of 122; P < 0.01). The accuracy of magnifying chromocolonoscopy for differentiating neoplastic lesions < or =5 mm was 94% (135 of 142), whereas that of conventional chromocolonoscopy was only 78% (69 of 89; P < 0.001). Results were not affected by the macroscopic types.. Magnifying chromocolonoscopy is superior to conventional chromocolonoscopy for the diagnosis of colorectal neoplastic lesions in the setting of a health testing center.

Topics: Adenomatous Polyps; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Female; Humans; Hyperplasia; Indigo Carmine; Intestinal Polyps; Male; Mass Screening; Middle Aged; Predictive Value of Tests; Prospective Studies; Rectal Diseases; Reproducibility of Results

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

Differential diagnosis between non-neoplastic and neoplastic lesions is very important at colonoscopy, since removal or biopsy of non-neoplastic polyps wastes time and resources. We therefore conducted a prospective study to examine whether indigo carmine dye spraying with and without magnification is more reliable than the conventional method for differential diagnosis.. 122 patients with 206 lesions of 10 mm or smaller were recruited into this study. All lesions detected on colonoscopy were first diagnosed using the conventional view, then at chromoendoscopy using 0.2 % indigo carmine, and finally at chromoendoscopy with magnification. The diagnosis at each step were recorded consecutively. All lesions were finally categorized as neoplastic or non-neoplastic according to pit pattern; non-neoplastic lesions were biopsied for histological evaluation, and all the neoplastic ones were removed endoscopically. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as reference.. Histologically, 46 lesions (22 %) were non-neoplastic and 160 (78 %) were neoplastic. The overall diagnostic accuracies by conventional view, chromoendoscopy, and chromoendoscopy with magnification were 84.0 % (173/206), 89.3 % (184/206) and 95.6 % (197/206), respectively.. Chromoendoscopy with magnification is the most reliable method for determining whether a colorectal lesion is non-neoplastic or neoplastic.

Topics: Adult; Aged; Aged, 80 and over; Colon; Colonoscopes; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Female; Humans; Hyperplasia; Indigo Carmine; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Rectum; Reproducibility of Results

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

To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.. Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standard-definition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained.. A total of 21 neoplastic lesions (2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients (70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5% (7/67 patients). The dysplasia detection yield was 20.8% (10/48) for targeted biopsies and 3.5% (11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval (CI): 26%-70%] and 96% (95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42% (95%CI: 27%-59%) and 97% (95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.. Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.

Topics: Adult; Aged; Biopsy; Colitis, Ulcerative; Colon; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Early Detection of Cancer; Feasibility Studies; Female; Humans; Hyperplasia; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity

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

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

Topics: Adenomatous Polyps; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Humans; Hyperplasia; Indigo Carmine; Intestinal Polyps; Mass Screening; Predictive Value of Tests; Rectal Diseases; Reproducibility of Results; Research Design

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

Topics: Aged; Colon; Colonic Polyps; Colonoscopy; Coloring Agents; Humans; Hyperplasia; Indigo Carmine; Male

Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening.. Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation.. The chi square method was used.. 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%.. Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Topics: Adenomatous Polyps; Adolescent; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Hyperplasia; Indigo Carmine; Male; Mass Screening; Predictive Value of Tests; Prospective Studies; Videotape Recording

We have introduced magnifying colonoscopy into clinical practice and analyzed its diagnostic efficacy, especially regarding the ability to distinguish neoplastic from non-neoplastic polyps.. The materials consisted of 923 polyps. After identifying the lesions during normal colonoscopy, a dye was sprayed, and then the zoom apparatus of the colonoscope was used to make a magnified observation at a maximum 100 times magnification. We classified the crypt orifices into six categories and labeled them A to F as follows: A, a medium round appearance; B, an asteroid appearance; C, an elliptic appearance; D, a small, round appearance; E, a cerebriform appearance; F, no apparent structural appearance.. Forty-two of 923 polyps did not reveal any clear images of crypt patterns. The percentage of histologically neoplastic change in the lesions classified as A, B, C, D, E, and F were 10, 15.9, 93.7, 100, 94.8, and 87.5 percent, respectively. When we considered types A and B to represent a crypt pattern of non-neoplastic lesions, and types C, D, E, and F to represent neoplastic lesions, and when the lesions that did not show any clear images were classified as a misjudgment, the diagnostic accuracy of neoplastic lesions (sensitivity) was 92 percent and that of non-neoplastic lesions (specificity) was 73.3 percent. Overall, the diagnostic accuracy in differentiating neoplastic from non-neoplastic lesions was 88.4 percent. Twenty-three neoplastic lesions that were misjudged to be non-neoplastic were histologically adenoma with mild atypia in 22 and adenoma with moderate atypia in 1.. Magnifying colonoscopy was considered to be useful in determining the indications for colonoscopic removal.

Topics: Adenomatous Polyps; Biopsy; Carcinoma; Chi-Square Distribution; Colonic Polyps; Colonoscopes; Colonoscopy; Coloring Agents; Diagnosis, Differential; Gentian Violet; Humans; Hyperplasia; Image Enhancement; Indigo Carmine; Intestinal Mucosa; Peutz-Jeghers Syndrome; Sensitivity and Specificity

During the last 10 years, we have experienced 41 cases of minute cancer, which is equivalent to 13.9% of all resected early stomach cancers. Out of 44 lesions in 41 cases, 17 lesions were diagnosed preoperatively, while 27 were unexpectedly detected by serial sections of the resected stomach. Most lesions were located along the lesser curvature of the body and antrum. There was no nodal involvement or vessel permeation. Histologically differentiated adenocarcinomas were encountered in 86.4%, associated with intensive intestinal mucosa in many cases. We have stressed that dye endoscopy using indigo carmine and methylene blue is very useful for the diagnosis of minute cancer.

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Adult; Aged; Female; Gastric Mucosa; Humans; Hyperplasia; Indigo Carmine; Male; Metaplasia; Methylene Blue; Middle Aged; Sex Factors; Staining and Labeling; Stomach Neoplasms