Chromoendoscopy: From a Research Tool to Clinical Progress

Abstract

Chromoendoscopy, the intravital staining of gastrointestinal epithelia, provides additional diagnostic information with respect to the epithelial morphology and pathophysiology. Based on experience gathered mainly in Japan, chromoendoscopy is now in more widespread use, in particular to identify preneoplastic and neoplastic lesions. The most promising techniques are the depiction of squamous epithelium neoplasia of the esophagus with Lugol’s solution, staining of Barrett’s mucosa by methylene blue, including the potential to identify neoplasia, and the demarcation of neoplasia with indigo carmine in stomach and colon for local endoscopic resection. However, the optimal methodology is still to be defined as well as diverging results of diagnostic accuracy to be clarified. High-resolution and magnifying endoscopy have breathed new life into chromoendoscopy. Innovative applications and refinement of the existing ones are soon to be expected.

The Role of Chromoendoscopy in the Surveillance of the Duodenum of Patients with Familial Adenomatous Polyposis

“…Chromoendoscopy is simple and inexpensive (little extra equipment is needed) and adds only a little extra time to the procedure [11,13,14,17,18]. Variation in adenoma detection rates could be attributed to the experience of the endoscopist.…”

“…Duodenal adenomatous lesions are frequently detected in postcolectomy patients, and to prevent their progression to invasive cancer, endoscopic surveillance is recommended [1][2][3][4][5][6][7][8]. To detect dysplasia and small mucosal abnormalities, chromoendoscopy is increasingly used in the gastrointestinal tract [9][10][11][12][13][14]. Indigo carmine is a "contrast dye" that has been used generally at a concentration of 0.5%-1% to diagnose Barrett's esophagus, to evaluate villous atrophy, and to diagnose polypoid and nonpolypoid lesions in the colon.…”

Meta‐analysis: The diagnostic efficacy of chromoendoscopy for early gastric cancer and premalignant gastric lesions

“…Although there are many treatment techniques and biomarkers for the diagnosis and prognosis of gastric cancer, currently, the over 5‐year survival rate of gastric cancer is approximately 50% in the new AJCC seventh version, and it is less than 50% in China . Recently, endoscopic examinations are being developed to overcome the problems caused by indirect and insensitive methods involving radiography and gastric cancer biomarkers . Chromoendoscopy (CE) has been used for the detection of gastrointestinal neoplasms, specifically for the diagnosis of early gastric cancer (EGC) and premalignant gastric lesions (PGLs) .…”

Chromoendoscopy in magnetically guided capsule endoscopy

“…Competing methods such as narrow-band imaging in the diagnosis of colorectal neoplasia are difficult to integrate in a capsule endoscope [11]. Furthermore, as in many endoscopic techniques the exact impact of chromoendoscopy and the technical details have not yet been established [24,25]. For example, in literature ([5,26,27]) one can find three different concentrations of Methylene blue dye and application times for the examination of gastric neoplasm.…”