Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University.
Post on 08-Jan-2018
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Chromocolonoscopy
Sashi Sagi MBBSAsst Prof of Clinical Medicine
Indiana University
Disclosures
• None
Outline
• What• Why• How• When• Guidelines
CHROMOENDOSCOPY
Image-enhanced endoscopy through the use of dye spraying or optical techniques
CHROMOENDOSCOPY
• Image enhancement – Mucosal structures – Recognition of borders – Surface topography
CHROMOENDOSCOPY
• Dyes– Indigo Carmine– Methylene Blue– Crystal Violet
CHROMOENDOSCOPY
• Dyes– Indigo Carmine– Methylene Blue– Crystal Violet
• Digital– Narrow-band imaging
(NBI)– Fujinon Intelligent
Color Enhancement (FICE)
– iScan
Chromocolonoscopy
Is there a need ?
Dye characteristics
Category
Methylene Blue
Vital
Indigo Carmine
Nonvital
Staining mechanism
• Active absorption by the epithelial cells
• Less or no absorption by inflamed mucosa and neoplasia
• Not absorbed by cells• Coats intestinal lining
Application Spray-catheter /water pump Spray-catheter / water pump
Concentration 0.1% 0.03- 0.5%
Duration 1 min for staining Lasts ~ 20mins
No wait timeLasts few minutes
Dye Application
Laine L et al. Gastroenterology 2015;148:639–651.
Dye Application
• Adequate colon prep• Lavage on insertion• Start in the Cecum• Suction excess dye
Laine L et al. Gastroenterology 2015;148:639–651.
Laine L et al. Gastroenterology 2015;148:639–651.
Chromo vs standard
• For Average-Risk pts
– Detected significantly more patients with at least one neoplastic lesion (OR 1.67)
– Significantly more patients with 3 or more neoplastic lesions (OR 2.55)
– 3 times greater detection of flat neoplasms
Brown SR et al Cochrane Database Syst Rev 2010;(10):CD006439.
Chromo vs HD
Kahi CJ et al . Am J Gastroenterol 2010;105(6):1301–7
Chromo vs standard
• Dysplasia detection in IBD
Laine L et al. Gastroenterology 2015;148:639–651.
Chromo vs HD
• Dysplasia detection in IBD– One prospective observational study – 75 patients – 16 (21%) vs 7 (9%); P = .007
Picco MF et al.Inflamm Bowel Dis 2013;19:1913–1920.
Guidelines
• No role in screening colonoscopy in average-risk patients.
• For surveillance in IBD– Recommended when performing standard white
light colonoscopy– Suggested when performing high-definition
colonoscopy
Laine L et al. Gastroenterology 2015;148:639–651.
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