indigo-carmine and Rectal-Diseases

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

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

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

It is difficult to secure the visual field during endoscopy for GI bleeding or colonoscopy without preparation because the injected water is rapidly mixed with fresh blood or stool. We developed a novel method to secure the visual field in these situations.. Clear gel with the appropriate viscosity to prevent rapid mixing is injected through the accessory channel, instead of water. A vinyl tube was used as an in vitro GI bleeding model. After filling the lumen with indigo carmine dye, air insufflation and water injection are not effective for securing the visual field. However, after gel injection, the bleeding source is observed clearly in the space occupied by the gel. The efficacy of this method was evaluated subjectively in clinical use. From February 2014 until June 2015, gel immersion was used in 17 consecutive patients when the visual field could not be secured with routine insufflation.. Of these 17 patients, gel injection was very effective in 10, effective in 5, slightly effective in 1, and not effective in 1. There were no adverse events associated with this method.. Gel immersion endoscopy is safe and effective for securing the visual field, creating a space for endoscopic visualization and treatment in otherwise difficult situations.

Topics: Aged; Aged, 80 and over; Coloring Agents; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Gels; Humans; Immersion; Indigo Carmine; Intestinal Obstruction; Jejunal Diseases; Male; Mallory-Weiss Syndrome; Middle Aged; Rectal Diseases; Sigmoid Neoplasms; Young Adult

Topics: Aged; Colonoscopy; Coloring Agents; Female; Humans; Indigo Carmine; Intestinal Mucosa; Prolapse; Rectal Diseases

Topics: Aged; Choristoma; Colonoscopy; Coloring Agents; Diagnosis, Differential; Gastric Mucosa; Humans; Indigo Carmine; Intestinal Mucosa; Male; Rectal Diseases; Rectal Neoplasms

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