indigo-carmine and Precancerous-Conditions

Although conventional colonoscopy is the most accurate test available for the investigation of the colorectum for polyps, data exist that raise concerns about its sensitivity. Chromoscopy (spraying dye onto the surface of the colon to make polyps more visible) may be one way of enhancing the ability of colonoscopy to detect polyps, particularly diminutive flat lesions, which otherwise may be difficult to detect.. To determine whether the use of chromoscopy enhances the detection of polyps and neoplasia during endoscopic examination of the colon and rectum.. We searched the following databases: Cochrane Colorectal Cancer Group Specialised Register (October 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library; Issue 10, 2015), MEDLINE (January 1950 to October 2015), EMBASE (January 1974 to October 2015), and ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (both November 2015). We also handsearched abstracts from relevant meetings from 1980 to 2015. Search terms included 'randomised trials' containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'.. We included all prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the whole of the colon and rectum. We excluded studies of people with inflammatory bowel disease or polyposis syndromes and any studies that combined chromoscopy with additional interventions (cap assistance, water-perfused, etc.).. Two review authors independently assessed the methodological quality of potentially eligible trials, and two review authors independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of participants with multiple neoplastic lesions, and the extubation time.. We included seven trials (2727 participants) in this update. Five trials were of sufficiently similar design to allow for pooled results. Two trials differed substantially in design and were included in a subgroup analysis. All the trials had some methodological drawbacks. However, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy was likely to yield significantly more people with at least one neoplastic lesion (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.31 to 1.79; 7 trials; 2727 participants), and at least one diminutive neoplastic lesion (OR 1.51, 95% CI 1.19 to 1.92; 4 trials; 1757 participants). Significantly more people with three or more neoplastic lesions were also detected, but only when studies that used high-definition colonoscopy in the control group were excluded (OR 4.63, 95% CI 1.99 to 10.80; 2 trials; 519 participants). None of the included studies reported any adverse events related to the use of the contrast dye.. There is strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. People with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.

Topics: Colonic Polyps; Colonoscopy; Humans; Indicators and Reagents; Indigo Carmine; Intestinal Polyps; Precancerous Conditions; Randomized Controlled Trials as Topic; Rectal Diseases

The indication of endoscopic submucosal dissection for Barrett's esophageal adenocarcinoma (BEA) is superficial BEA without lymph node metastasis. The characteristic endoscopic findings of superficial BEA are elevation, depression, and color change. Indigocarmine spreading is useful for the diagnosis of lateral extension. It is a simple and easy enhancement method. The observation of surface and vascular pattern by magnifying endoscopy with narrow-band imaging is also useful for the diagnosis of lateral extension. The incidence of gastric cancer is high in Japan. The majority of early gastric cancer is detected by conventional endoscopy without random biopsy, or target biopsydiagnosis. The background mucosa of gastric cancer has gastritis, and the carcinogenesis based on inflammation is the same as early BEA. However, random biopsy remains the universal standard for early detection of Barrett's high-grade dysplasia and superficial BEA. A surveillance system that does not use random biopsy can and should be established using high-resolution endoscopy with target biopsy.

Topics: Adenocarcinoma; Barrett Esophagus; Biopsy; Cell Transformation, Neoplastic; Coloring Agents; Dissection; Esophageal Neoplasms; Esophagoscopy; Gastric Mucosa; Gastroscopy; Humans; Image Enhancement; Indigo Carmine; Japan; Narrow Band Imaging; Neoplasm Grading; Neoplasm Invasiveness; Precancerous Conditions; Stomach Neoplasms

Given its morbidity and mortality, the early detection and diagnosis of gastric cancer is an area of intense research focus. This article reviews the emerging use of enhanced endoscopic imaging technologies in the detection and management of gastric cancer. The combined use of white-light endoscopy with enhanced imaging technologies, such as magnification narrow-band imaging, chromoendoscopy, and autofluorescence endoscopy, demonstrates promise in the improved ability to detect and delineate gastric neoplasia. However, widespread clinical use is still limited, mainly because of the restricted availability of the technologies.

Topics: Acetic Acid; Adenocarcinoma; Coloring Agents; Early Detection of Cancer; Gastroscopy; Humans; Indigo Carmine; Methylene Blue; Narrow Band Imaging; Optical Imaging; Precancerous Conditions; Stomach Neoplasms

Because endoscopic submucosal dissection (ESD) of gastric cancer can only be curative if the cancer is detected at an early stage and a precise preoperative diagnosis is made, we reviewed the detection and characterization of early gastric cancer (EGC) using both conventional endoscopy with white-light imaging (C-WLI) and image-enhanced endoscopy (chromoendoscopy [CE] and magnifying narrow-band imaging [M-NBI]). Systematic screening of the stomach by C-WLI after ideal preparation of the patient is important for detecting a mucosal lesion, which can then be characterized using CE. However, a limitation of C-WLI with CE is the diagnosis of flat or small gastric cancers. To overcome this, M-NBI together with a comprehensive diagnostic system, termed the 'vessel plus surface classification' system, was developed and has proven very useful. Preoperative assessment for ESD involves determining: (i) histological type; (ii) size; (iii) depth of invasion; (iv) presence or absence of associated ulceration; and (v) horizontal extent of the cancer. A limitation of endoscopic diagnosis using M-NBI is the histologically undifferentiated type of carcinoma, in which case the biopsy specimen is used to make a histopathological diagnosis.

Topics: Biopsy; Coloring Agents; Diagnosis, Differential; Dissection; Early Diagnosis; Gastric Mucosa; Gastritis; Gastroscopy; Image Enhancement; Indigo Carmine; Mass Screening; Microvessels; Narrow Band Imaging; Neoplasm Invasiveness; Neoplasm Staging; Precancerous Conditions; Prognosis; Stomach Neoplasms; Stomach Ulcer

Although conventional colonoscopy is the most sensitive test available for the investigation of the colorectum for polyps, there are data that raise concerns about its sensitivity. Chromoscopy may be one way of enhancing the ability for colonoscopy to detect polyps particularly diminutive flat lesions that may be otherwise difficult to detect.. To determine whether the use of chromoscopy enhances detection of polyps and neoplasia during endoscopic examination of the colon and rectum.. MEDLINE, EMBASE and the Cochrane Library databases were searched (April 2010) along with a hand search of abstracts from relevant meetings. Search terms included randomised trials containing combinations of the following: 'chromoscopy' 'colonoscopy' 'dye-spray' 'chromo-endoscopy' 'indigo-carmine' 'magnifying endoscopy'.. All prospective randomised trials comparing chromoscopic with conventional endoscopic examination of the lower gastrointestinal tract were included. Patients with inflammatory bowel disease or polyposis syndromes were excluded.. Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trials. Outcome measures included the detection of polyps (neoplastic and non-neoplastic), the detection of diminutive lesions, the number of patients with multiple neoplastic lesions and the extubation time.. Five trials were included in this update, and although there were some methodological drawbacks and differences in study design, combining the results showed a significant difference in favour of chromoscopy for all detection outcomes. In particular, chromoscopy is likely to yield significantly more patients with at least one neoplastic lesion (OR 1.67 (CI 1.29-2.15)) and significantly more patients with three or more neoplastic lesions (OR 2.55 (CI 1.49-4.36)). Not surprisingly the withdrawal times were significantly slower for the chromoscopy group.. There appears to be strong evidence that chromoscopy enhances the detection of neoplasia in the colon and rectum. Patients with neoplastic polyps, particularly those with multiple polyps, are at increased risk of developing colorectal cancer. Such lesions, which presumably would be missed with conventional colonoscopy, could contribute to the interval cancer numbers on any surveillance programme.

Topics: Colonic Polyps; Colonoscopy; Humans; Indicators and Reagents; Indigo Carmine; Intestinal Polyps; Precancerous Conditions; Randomized Controlled Trials as Topic; Rectal Diseases

Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.. From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.. Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V.. CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.. NCT02543762.

Topics: Adult; Aged; Clinical Competence; Colitis, Ulcerative; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Crohn Disease; Early Detection of Cancer; Education, Medical, Continuing; Female; Humans; Indigo Carmine; Inflammatory Bowel Diseases; Learning Curve; Male; Middle Aged; Precancerous Conditions; Prospective Studies

To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.. Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.. Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).. NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Topics: Acetic Acid; Adult; Aged; Aged, 80 and over; Coloring Agents; Epinephrine; Female; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Precancerous Conditions; Prospective Studies; Sensitivity and Specificity; Staining and Labeling; Stomach Neoplasms

Narrow-band imaging (NBI) is a novel technique that may represent an alternative method to chromoendoscopy (CE) for the detection of colitis-associated intraepithelial neoplasia (IN) in patients with long-standing inflammatory bowel disease (IBD).. To compare NBI with CE for the detection of IN.. Prospective, randomized, crossover study.. Academic hospital.. Patients with clinically inactive colonic IBD (≥8 years).. Patients underwent both CE and NBI in randomized order. Targeted biopsy specimens from abnormal areas were obtained. Pathological examination was regarded as the reference standard.. Number of false-positive and true-positive lesions in patients undergoing CE and NBI were compared as well as the proportion of patients with missed IN lesions.. Eighty patients were screened, of whom 20 were excluded. Mean ± standard deviation withdrawal time for CE was significantly longer than that for NBI (26.87 ± 9.89 minutes vs 15.74 ± 5.62 minutes, P < .01). Thirteen patients had at least 1 IN lesion on 1 of the examinations. In the per-lesion analysis, NBI resulted in a significantly inferior false-positive biopsy rate (P = .001) and a similar true-positive rate. The percentage of missed IN lesions and patients was superior with NBI, albeit without reaching statistical significance.. Lesions were sampled immediately after detection, which precluded the possibility of paired analysis.. NBI appears to be a less time-consuming and equally effective alternative to CE for the detection of IN. However, given the NBI lesion and patient miss rates, it cannot be recommended as the standard technique.

Topics: Biopsy; Carcinoma in Situ; Colonic Neoplasms; Colonoscopes; Colonoscopy; Coloring Agents; Cross-Over Studies; Female; Humans; Image Enhancement; Indigo Carmine; Inflammatory Bowel Diseases; Intestinal Mucosa; Male; Middle Aged; Precancerous Conditions; Sensitivity and Specificity

High-resolution endoscopy (HRE) may improve the detection of early neoplasia in Barrett's esophagus. Indigo carmine chromoendoscopy (ICC) and narrow-band imaging (NBI) may be useful techniques to complement HRE. The aim of this study was to compare HRE-ICC with HRE-NBI for the detection of high-grade dysplasia or early cancer (HGD/EC) in patients with Barrett's esophagus.. Twenty-eight patients with Barrett's esophagus underwent HRE-ICC and HRE-NBI (separated by 6 - 8 weeks) in a randomized sequence. The two procedures were performed by two different endoscopists, who were blinded to the findings of the other examination. Targeted biopsies were taken from all detected lesions, followed by four-quadrant biopsies at 2-cm intervals. Biopsy evaluation was supervised by a single expert pathologist, who was blinded to the imaging technique used.. Fourteen patients were diagnosed with HGD/EC. The sensitivity for HGD/EC was 93 % and 86 % for HRE-ICC and HRE-NBI, respectively. Targeted biopsies had a sensitivity of 79 % with HRE alone. HGD was diagnosed from random biopsies alone in only one patient. ICC and NBI detected a limited number of additional lesions occult to HRE, but these lesions did not alter the sensitivity for identifying patients with HGD/EC.. In most patients with high-grade dysplasia or early cancer in Barrett's esophagus, subtle lesions can be identified with high-resolution endoscopy. Indigo carmine chromoendoscopy and narrow-band imaging are comparable as adjuncts to high-resolution endoscopy.

Topics: Administration, Topical; Aged; Barrett Esophagus; Biopsy; Coloring Agents; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Humans; Indigo Carmine; Intestinal Mucosa; Male; Precancerous Conditions; Prospective Studies; Sensitivity and Specificity; Severity of Illness Index; Video Recording

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

Discrimination between neoplastic and non-neoplastic colorectal polyps is essential for determining appropriate treatment. The mucosal crypt pattern of polyps can be observed with a nonmagnifying colonoscope; however, mucosal crypt patterns are better seen by magnifying colonoscopy, which can also be a noninvasive means for predicting histopathology. This study prospectively compared the ability to distinguish between neoplastic and non-neoplastic lesions by magnifying and nonmagnifying colonoscopy.. Six hundred sixty patients were randomly assigned to undergo magnifying or nonmagnifying colonoscopy (2 groups each of 330 patients). The mucosal crypt pattern of colorectal lesions was classified into types I through V after spraying with 0.2% Indigo carmine dye. The histopathology of all lesions was confirmed by evaluation of endoscopic resection specimens or biopsy specimens. Only lesions 10 mm or less in diameter were included in the study.. The accuracy of magnifying colonoscopy in distinguishing neoplastic from non-neoplastic lesions (92%, 372/405) was significantly higher than for nonmagnifying colonoscopy (68%, 278/407). Insertion of magnifying and nonmagnifying colonoscopes to the cecum was successful in, respectively, 321 patients (97%) and 317 patients (96%), with no significant differences in the average time to reach the cecum or average total procedure time. No serious complication was observed during or immediately after the examinations.. Observation of mucosal crypt pattern with magnifying colonoscopy is superior to nonmagnifying colonoscopy for distinguishing between neoplastic and non-neoplastic colorectal lesions.

Topics: Colonic Polyps; Colonoscopy; Coloring Agents; Diagnosis, Differential; Humans; Indigo Carmine; Intestinal Mucosa; Precancerous Conditions; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity

To investigate the diagnostic value of endoscopic narrow-band imaging technique in early gastric cancer and precancerous lesions.. A total of 100 patients with recurrent upper gastrointestinal symptoms in our hospital from January 2017 to January 2022 were selected and divided into group A and group B according to the random number table method, with 50 cases in each group. Group A received white light endoscopy, and group B received narrow-band imaging technology combined with endoscopy. Narrow-band imaging combined with magnifying endoscopy was used to stain the area with suspicious mucosal lesions with indigo carmine and magnified observation.. The endoscopic image clarity of group B was significantly better than that of group A in terms of lesion outline, gastric pit, and microvascular morphology (. The value of narrow-band imaging technology combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer is better than that of ordinary white light endoscopy, and it can be widely used in clinical practice.

Topics: Endoscopy; Humans; Indigo Carmine; Narrow Band Imaging; Precancerous Conditions; Stomach Neoplasms

Premalignant gastric lesions have an increased risk to develop gastric cancer.. To evaluate the usefulness of systematic endoscopy that includes chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions.. This longitudinal, prospective study was performed in patients with gastric atrophy, intestinal metaplasia or dysplasia who were referred for endoscopy less than 6 months after the initial diagnosis. The second endoscopy was performed in three phases: phase 1, exhaustive and systematic review of the mucosa with photographic documentation and biopsies of suspicious areas; phase 2, chromoendoscopy with a double dye staining technique using acetic acid 1.2% and indigo carmine 0.5%; phase 3, topographic mapping and random biopsies.. A total of 50 patients were included. Nine (18%) had atrophic gastritis, 38 (76%) had intestinal metaplasia, and 3 (6%) had low-grade dysplasia. Systematic endoscopy with chromoendoscopy using a double dye staining technique detected more patients with dysplasia (9 versus 3, p<.05), and a larger number of biopsies with the diagnosis of dysplasia were obtained. This occurred for visible (6 vs. 0, p<.05) and non-visible lesions (6 vs. 3, p=NS). In one patient, initial low-grade dysplasia was not detected again in the systematic endoscopy, giving a global endoscopic performance for the detection of lesions of 92%.. Patients with premalignant gastric lesions have synchronous lesions with greater histological severity, which are detected when systematic endoscopy is conducted with indigo carmine dye added to acetic acid.

Topics: Endoscopy; Gastric Mucosa; Humans; Indigo Carmine; Longitudinal Studies; Precancerous Conditions; Prospective Studies; Staining and Labeling; Stomach Neoplasms

Chromoendoscopy is a dye enhancement technique that uses epithelial tissue dyeing for assessing any changes in it by determining its characteristics and eventually to improving mucosal lesions detection at endoscopy. Currently with the addition of a joint use of rigid endoscopes and video systems at surgery, visualization of the larynx and trachea areas significantly improved with wide angle viewing. However, in certain diseases, such as laryngeal papillomatosis, certain conditions were overlooked by these approaches and with the likelihood of postoperative early relapse. With the addition of chromoendoscopy to endoscopic laryngeal surgery, we were able to increase the ability to recognize intraoperatively inconspicuous lesions, improve lesion limit visualization, observe in detail their surfaces, and determine as well the existence of residual lesion if any after surgical removal.. To prove the helpfulness of chromoendoscopy in otolaryngology as an innovative diagnostic technique associated with laryngeal endoscopical surgery.. The present study uses contrast dyeing agents such as indigo carmine as endoscopic tissue staining and, incidentally, which is the most widely used detection method in gastroenterology. The dye fills the interstices, highlighting irregularities, such as depressions and elevations in architecture.. This diagnostic enhancing technique was used with six patients who presented recurrent laryngeal papillomatosis. We committed ourselves to get the most out of the intraoperative diagnostic yield and reduce the relapse likelihoods in all cases.. Chromoendoscopy joined with endoscopic laryngeal surgery is an excellent intraoperative diagnostic approach in the management of laryngeal invasive conditions such as laryngeal papillomatosis.

Topics: Adolescent; Adult; Aged; Chromogenic Compounds; Female; Humans; Indigo Carmine; Laryngeal Neoplasms; Laryngoscopy; Male; Middle Aged; Papilloma; Papillomavirus Infections; Precancerous Conditions; Predictive Value of Tests; Respiratory Tract Infections; Treatment Outcome

Serrated polyposis syndrome is a rare condition in which multiple serrated lesions develop all over the colon, which is thought to be associated with an increased risk for the development of cancer. The aim of this study was to investigate the feasibility of endoscopic treatment and standardised surveillance in patients with this increasingly recognised syndrome.. From September 2010 to November 2013, consecutive patients were included in a prospective study. All patients underwent chromoendoscopy at first presentation and during surveillance. Follow-up examinations were carried out at 3 month intervals until complete clearance was achieved. Afterwards, patients entered a standardised surveillance protocol with a chromoendoscopic colonoscopy annually.. Altogether 100 colonoscopies were carried out in 28 patients, with endoscopic resection of 436 lesions. Total clearance was accomplished in 27 patients (96.0 %) after 2.5 colonoscopies (range 1 - 8). Histology revealed 359 hyperplastic polyps (82.3 %), 37 sessile serrated adenomas (8.5 %), 36 low-grade adenomas (8.3 %), and one patient with advanced colorectal cancer. Twelve patients (42.8 %) had serrated polyps > 10 mm in size. During the surveillance period, 86 additional lesions were detected and resected. The mean follow-up period was 21.5 months (range 2 - 39 months). No interval carcinoma was detected during the surveillance.. The present study indicates that endoscopic management in patients who meet the diagnostic criteria for serrated polyposis syndrome is feasible and safe. In particular, the incidence of colorectal cancer in this cohort was lower in comparison with previous studies.

Topics: Adenomatous Polyposis Coli; Administration, Topical; Adult; Aged; Cohort Studies; Colonic Neoplasms; Colonoscopy; Disease Progression; Feasibility Studies; Female; Follow-Up Studies; Humans; Incidence; Indigo Carmine; Male; Middle Aged; Precancerous Conditions; Prospective Studies; Rectal Neoplasms; Tertiary Care Centers; Treatment Outcome; Uterine Cervical Dysplasia

Mucosal dye spraying (chromoendoscopy [CE]) has been shown in controlled studies to enhance lesion detection in colitis surveillance. Narrow band imaging (NBI) potentially offers a more convenient mode of highlighting mucosal lesions. The primary objectives of this study were to compare CE and NBI in colitis surveillance with respect to lesion detection. A secondary objective was to assess the accuracy of the mucosal pit pattern (Kudo classification) with NBI in predicting mucosal histology.. Patients with colitis of 8 years or greater disease duration underwent screening colonoscopy with NBI, followed immediately by CE by 2 endoscopists blinded to each other's results. All lesions were biopsied to confirm histology. Diagnostic yield of each modality for dysplastic lesions. Accuracy of Kudo classification by NBI for neoplasia.. Forty-four participants were enrolled. One hundred forty-four colonic lesions were identified in total. Overall, CE identified more lesions than NBI (131 versus 102, P < 0.001); however, most were nondysplastic. CE detected 23 neoplastic (dysplastic or indefinite for dysplasia) lesions in 11 patients and NBI 20 lesions in 10 patients, P = 0.180. Kudo assessment by NBI had low sensitivity for dysplasia (42%) and modest accuracy (74%) for dysplasia.. NBI detected fewer lesions than CE in chronic colitis; however, most were not dysplastic. There was a nonsignificant trend in favor of CE for detection of dysplasia. At present, NBI cannot be recommended as an alternative to CE for dysplasia surveillance in colitis.

Topics: Colitis, Ulcerative; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Crohn Disease; Early Detection of Cancer; Endoscopy; Female; Follow-Up Studies; Humans; Indigo Carmine; Male; Middle Aged; Narrow Band Imaging; Precancerous Conditions; Prognosis

Several advanced imaging techniques have been developed to improve differentiation of colorectal lesions. These techniques need to be assessed for both feasibility and accuracy in order to prove their value in daily clinical practice. The current study assessed the feasibility of probe-based confocal laser endomicroscopy (pCLE) in acquiring videos of sufficient quality. Furthermore, the accuracy of pCLE for the differentiation of colorectal lesions was assessed and compared with narrow-band imaging (NBI) and chromoendoscopy (CE).. Consecutive patients scheduled for surveillance colonoscopy at our centre were included. All procedures were performed by two expert colonoscopists, who previously participated in studies evaluating pCLE, NBI, and CE. All detected lesions during colonoscopy were differentiated real-time with NBI and CE for Kudo pit pattern. Lesions were also assessed real-time for vascular pattern intensity (VPI) during NBI. Subsequently, pCLE videos of each lesion were acquired and biopsies were taken for histopathology. All pCLE videos were assessed post-hoc for the percentage of time demonstrating sufficient image quality (i.e., depicting at least one crypt or vessel). Finally, pCLE videos were assessed post-hoc for diagnostic accuracy by two experts.. A total of 154 lesions detected in 64 patients were included. Accuracy of Kudo pit pattern with NBI for predicting neoplasia (88.7%) was significantly better than accuracy of VPI (77.5%, P = 0.05) but not significantly different from CE (89.3%, P = 0.125). During pCLE, no histology was shown at all on the video in 19 lesions (12%). The mean time to acquire a pCLE video of the remaining 135 lesions was 50 seconds (s.d. 47) per lesion. The median percentage demonstrating sufficient quality per video was 40.5% (interquartile range 21.2-67.0). Accuracy of pCLE for both observers (66.7 and 71.9%) was significantly lower than accuracy of CE (P < 0.001) and NBI (P < 0.001).. Video acquisition with pCLE could not be achieved in a small number of lesions. The majority of pCLE videos demonstrated insufficient quality in more than half of the time recorded. Moreover, post-hoc accuracy of pCLE was significantly lower in comparison with real-time accuracy of CE and NBI. Future research should assess whether further increase in experience could improve pCLE video acquisition and determine the real-time accuracy of pCLE for differentiating colorectal lesions.

Topics: Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Diagnosis, Differential; Feasibility Studies; Female; Fluorescein; Fluorescent Dyes; Humans; Indigo Carmine; Male; Microscopy, Confocal; Middle Aged; Precancerous Conditions; Sensitivity and Specificity; Video Recording

Patients with ulcerative colitis and Crohn's colitis have increased risk of colorectal cancer. Current screening endoscopy protocols based on white light endoscopy (WLE) and random biopsies are laborious and of uncertain sensitivity. Novel endoscopic techniques include chromoendoscopy (CE) and confocal laser endomicroscopy (CLE).. The aim was to compare WLE and CE for the detection of intraepithelial neoplasia (IEN). Furthermore, we analysed the sensitivity and specificity of CE and CLE for the diagnosis of IEN.. The cohort consisted of 30 patients examined by WLE, CE with 0.4% indigocarmine, and by a CLE system Pentax EC-3870CIFK during one examination. Additional 15 patients were examined by conventional protocol only. Random biopsies and biopsies from all suspicious lesions were taken. We compared the number of IENs detected by WLE and CE and analysed the predictive values of CE and CLE for the histology diagnosis.. There were 1584 random biopsies (35.2 per patient) taken. There were 78 targeted biopsies (1.7 per patient) taken in 24 of 45 patients examined by WLE and an additional 36 biopsies in 16 of 30 patients examined by CE (1.17 additional per patient). There were no IENs found on random biopsies versus six low-grade or high-grade IENs in four patients (two detected by WLE, four additional by CE) from targeted biopsies, P=0.02. A total of 100 suspicious lesions were detected and analysed by CE and histology. CLE could not examine 32 of 100 lesions (two of 30 flat vs. 30 of 70 pedunculated lesions, P=0.0002, odds ratio 10.5). The sensitivity of CE/CLE for low-grade or high-grade IEN was 100/100%, the specificity 96.8/98.4%, positive predictive value was 62.5/66.7% and negative predictive value was 100/100%.. Targeted biopsies are superior to random biopsies in the screening of IEN in patients with inflammatory bowel disease. CE increases the diagnostic yield of WLE. In our study CLE did not provide additional clinical benefits.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma in Situ; Child; Colitis, Ulcerative; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Crohn Disease; Early Detection of Cancer; Female; Humans; Indigo Carmine; Male; Microscopy, Confocal; Middle Aged; Precancerous Conditions; Young Adult

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

The aim of this study was to compare magnified still images obtained with high-resolution white light endoscopy, indigo carmine chromoendoscopy, acetic acid chromoendoscopy, and narrow-band imaging to determine the best technique for use in Barrett's esophagus.. We obtained magnified images from 22 areas with the 4 aforementioned techniques. Seven endoscopists with no specific expertise in Barrett's esophagus or advanced imaging techniques and 5 international experts in this field evaluated these 22 areas for overall image quality, mucosal image quality, and vascular image quality. In addition, the regularity of mucosal and vascular patterns and the presence of abnormal blood vessels were evaluated, and this was correlated with histology.. The interobserver agreement for the 3 features of mucosal morphology with white light images ranged from kappa = 0.51 (95% confidence interval [CI]: 0.46-0.55) to kappa = 0.53 (95% CI: 0.50-0.57) for all observers, from kappa = 0.43 (95% CI: 0.33-0.54) to kappa = 0.53 (95% CI: 0.41-0.64) for experts, and from kappa = 0.51 (95% CI: 0.15-0.33) to kappa = 0.64 (95% CI: 0.58-0.70) for nonexperts. The interobserver agreement in these groups did not improve by adding one of the enhancement techniques. The yield for identifying early neoplasia with white light images was 86% for all observers, 90% for experts, and 84% for nonexperts. The addition of enhancement techniques did not improve the yield neoplasia.. The addition of indigo carmine chromoendoscopy, acetic acid chromoendoscopy, or narrow-band imaging to white light images did not improve interobserver agreement or yield identifying early neoplasia in Barrett's esophagus.

Topics: Acetic Acid; Aged; Aged, 80 and over; Barrett Esophagus; Coloring Agents; Esophageal Neoplasms; Esophagoscopy; Esophagus; Female; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Mucous Membrane; Observer Variation; Precancerous Conditions; Reproducibility of Results

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

Recent data suggest that panchromoscopy using methylene blue can improve the detection of intraepithelial neoplastic lesions in the context of surveillance colonoscopy for patients with chronic ulcerative colitis. This method has also been shown to provide a more accurate diagnosis of the extent of disease and inflammatory activity. Interval cancers are known to occur in patients with chronic ulcerative colitis despite the adoption of currently accepted surveillance biopsy protocols. We hypothesised that targeted chromoscopy alone, with high-magnification imaging, may increase the total number of intraepithelial neoplastic lesions detected, compared with conventional colonoscopy and biopsy surveillance according to current protocols.. A total of 350 patients with long-standing ulcerative colitis (>or=8 years) underwent surveillance colonoscopy using high-magnification chromoscopic colonoscopy (HMCC). Quadrantic biopsies at 10-cm intervals were taken on extubation in addition to targeted biopsies of abnormal mucosal areas. Defined lesions were further evaluated using modified Kudo crypt pattern analysis. These data were compared with data from 350 disease duration- and disease extent-matched control patients who had undergone conventional colonoscopic surveillance between January 2001 and April 2005.. Significantly more intraepithelial neoplastic lesions were detected in the magnification chromoscopy group compared with controls (69 vs. 24, P<0.0001). Intraepithelial neoplasia was observed in 67 lesions, of which 53 (79%) were detected using magnification chromoscopy alone. Chromoscopy increased the number of flat lesions with intraepithelial neoplasia detected compared with controls (P<0.001). Twenty intraepithelial neoplastic lesions were detected from 12,850 non-targeted biopsies in the HMCC group (0.16%), while 49 intraepithelial neoplastic lesions were detected from the 644 targeted biopsies in the HMCC group (8%). From 12,482 non-targeted biopsies taken in the control group patients, 18 (0.14%) showed intraepithelial neoplasia. The yield of intraepithelial neoplastic lesions from targeted biopsies in the control group (i. e. without HMCC imaging), however, was only modestly improved at 1.6% (6/369). Using modified Kudo criteria, the sensitivity and specificity for differentiating neoplastic from non-neoplastic lesions using HMCC were 93% and 88% respectively. The total procedure time was significantly longer in the HMCC group compared with controls (P<0.02).. Magnification chromoscopy improves the detection of intraepithelial neoplasia in the endoscopic screening of patients with chronic ulcerative colitis. Neoplastic and non-neoplastic mucosal change can be predicted with a high overall accuracy using magnification techniques. These adjunctive endoscopic techniques have important clinical implications and may lead to changes in current practice guidelines.

Topics: Biopsy, Needle; Carcinoma in Situ; Cohort Studies; Colitis, Ulcerative; Colonic Neoplasms; Colonoscopy; Evaluation Studies as Topic; Female; Humans; Image Enhancement; Immunohistochemistry; Indigo Carmine; Male; Precancerous Conditions; Probability; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Statistics, Nonparametric

The aim of this study was to investigate detection of dysplasia or colitic cancer with ulcerative colitis by use of magnifying endoscopic observation.. From 1986 through 2000, ulcerative colitis was diagnosed and treated in 886 patients at Kitasato University East Hospital. Of the total, we studied 25 patients in depth: 14 who had dysplasia alone, 5 in whom cancer was diagnosed during follow-up after the detection of dysplasia, and 6 who had colitic cancer.. Dysplasia was detected in 11 (3.2 percent) of 345 patients with extensive colitis and in 8 (3.7 percent) of 217 with left-sided colitis. Colorectal cancer was diagnosed in nine patients (2.6 percent) with extensive colitis and in two (0.9 percent) with left-sided colitis. Neither dysplasia nor colitic cancer was found in patients with proctitis-type colitis. Endoscopically, dysplasia and early cancer were characterized by granular or nodular protruding mucosa or by lowly protruding or flat mucosa, often associated with redness. Dye-spraying endoscopy was useful for detection. Magnifying endoscopy of ten regions of dysplasia (7 patients) and five early cancers (4 patients) showed IIIS to IIIL type pits or IV type pits. Biopsy of sites showing tumorous pits on magnifying endoscopy revealed dysplasia and early cancer. Observation of the pit pattern was found to be diagnostically useful.. Dye spraying and magnifying endoscopy are useful for the detection, targeted biopsy, and diagnosis of dysplasia and colitic cancer in patients with ulcerative colitis.

Topics: Adult; Aged; Colitis, Ulcerative; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Precancerous Conditions

The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett's oesophagus with the risk of future malignant transformation. The distribution of both IM and dysplasia (low grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is patchy and mosaic requiring random biopsies. Techniques that could help target areas of high yield within Barrett's mucosa would be helpful.. To study the utility of high magnification chromoendoscopy (MCE) in the detection of IM, LGD, and HGD in patients with Barrett's oesophagus.. Consecutive patients detected with columnar mucosa in the distal oesophagus were studied using an Olympus magnification endoscope (GIF-Q16OZ, 115x). The distal oesophagus was sprayed with indigo carmine solution and the oesophageal columnar mucosa patterns were noted under high magnification and targeted for biopsy. All biopsies were read by pathologists blinded to the endoscopic findings.. Eighty patients with suspected Barrett's oesophagus (that is, columnar lined distal oesophagus) were studied: mean age 62.7 years (range 35-81). Mean length of columnar mucosa was 3.7 cm (range 0.5-17). Three types of mucosal patterns were noted within the columnar mucosa after spraying indigo carmine and using MCE: ridged/villous pattern, circular pattern, and irregular/distorted pattern. The yield of IM on target biopsies according to the patterns was: ridged/villous 57/62 (97%) and circular 2/12 (17%). Six patients had an irregular/distorted pattern and all had HGD on biopsy (6/6 (100%)). Eighteen patients had LGD on target biopsies; all had the ridged/villous pattern. All patients with long segment Barrett's were identified using MCE whereas 23/28 patients (82%) with short segment Barrett's had the ridged/villous pattern.. MCE helps visually identify areas with IM and HGD having specific patterns but not patients with LGD (appear similar to IM). MCE may be a useful clinical tool for the increased detection of patients with IM as well as for surveillance of patients for the detection of HGD. If these preliminary results are validated, MCE would help identify high yield areas, potentially eliminating the need for random biopsies.

Topics: Adult; Aged; Aged, 80 and over; Barrett Esophagus; Coloring Agents; Esophageal Neoplasms; Esophagoscopy; Esophagus; Female; Humans; Indigo Carmine; Intestines; Male; Metaplasia; Middle Aged; Mucous Membrane; Precancerous Conditions; Predictive Value of Tests; Sensitivity and Specificity

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