Chromoendoscopy

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Chromoendoscopy is an endoscopic technique that uses stains during endoscopy to highlight differences in mucosa, as well as dysplastic and malignant changes that are not apparent in white light. Chromoendoscopy is used to increase the detection rates for various pathologic processes during endoscopy. Chromoendoscopy is often used in surveillance of the esophagus for Barrett esophagus, evaluation of polyps in the colon, and surveillance of dysplasia in inflammatory bowel disease (IBD). ^{[1, 2]}

Initial evaluations of computerized virtual chromoendoscopy for screening colonoscopy showed efficacy similar to that of chromoendoscopy, without the logistical difficulties or preparing and applying vital dyes. ^{[3, 4]}  Magnification endoscopy, spectroscopy, confocal laser endomicroscopy and endocytoscopy have important roles in the evaluation of IBD and surveillance of chronic ulcerative colitis (UC). ^{[5, 6, 7]}  Use of these techniques in Barrett esophagus has also led better detection of dysplasia, particularly in the absence of discrete lesions. ^[8]

Chromoendoscopy has been used in the evaluation of Barrett esophagus, ^{[9, 10, 11]}  esophageal adenocarcinoma, ^[12]  gastric metaplasia and adenocarcinoma, ^{[13, 14, 15, 16]}  colon polyps, ^{[17, 18]}  colon cancer, ^{[19, 20, 21, 22, 23]}  and surveillance in IBD. ^[24]

The contraindications to chromoendoscopy would be any of the usual contraindications to endoscopy or a history of an allergic reaction to the dye or stain used in the specific clinical situation.

Chromoendoscopy is not routinely performed during general endoscopy. It is performed in centers that specialize in this field or on a case-by-case basis as indicated by the clinical situation and dictated by the experience of the endoscopist and the center.

Wong Kee Song LM, Adler DG, Chand B, Conway JD, Croffie JM, Disario JA, et al. Chromoendoscopy. Gastrointest Endosc. 2007 Oct. 66(4):639-49. [Medline].

Buchner AM. The Role of Chromoendoscopy in Evaluating Colorectal Dysplasia. Gastroenterol Hepatol (N Y). 2017 Jun. 13 (6):336-347. [Medline].

dos Santos CE, Lima JC, Lopes CV, Malaman D, Salomao AD, Garcia AC. Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: a randomized and prospective study. Eur J Gastroenterol Hepatol. 2010 Nov. 22(11):1364-71. [Medline].

Pohl J, Lotterer E, Balzer C, Sackmann M, Schmidt KD, Gossner L. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gut. 2009 Jan. 58(1):73-8. [Medline].

Neumann H, Neurath MF, Mudter J. New endoscopic approaches in IBD. World J Gastroenterol. 2011 Jan 7. 17(1):63-8. [Medline].

Teubner D, Kiesslich R, Matsumoto T, Rey JW, Hoffman A. Beyond standard image-enhanced endoscopy confocal endomicroscopy. Gastrointest Endosc Clin N Am. 2014 Jul. 24(3):427-34. [Medline].

Jang HW, Park SJ, Cheon JH, Kim TI, Kim WH, Hong SP. Does magnifying narrow-band imaging or magnifying chromoendoscopy help experienced endoscopists assess invasion depth of large sessile and flat polyps?. Dig Dis Sci. 2014 Jul. 59(7):1520-8. [Medline].

Reddymasu SC, Sharma P. Advances in endoscopic imaging of the esophagus. Gastroenterol Clin North Am. 2008 Dec. 37(4):763-74, vii. [Medline].

Panossian AM, Raimondo M, Wolfsen HC. State of the art in the endoscopic imaging and ablation of Barrett’s esophagus. Dig Liver Dis. 2011 May. 43(5):365-73. [Medline].

Qumseya BJ, Wang H, Badie N, Uzomba RN, Parasa S, White DL, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013 Dec. 11 (12):1562-70.e1-2. [Medline].

Tholoor S, Bhattacharyya R, Tsagkournis O, Longcroft-Wheaton G, Bhandari P. Acetic acid chromoendoscopy in Barrett’s esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). Gastrointest Endosc. 2014 Sep. 80 (3):417-24. [Medline].

Seewald S, Ang TL, Groth S, Zhong Y, Bertschinger P, Altorfer J. Detection and endoscopic therapy of early esophageal adenocarcinoma. Curr Opin Gastroenterol. 2008 Jul. 24(4):521-9. [Medline].

Ohnita K, Isomoto H, Shikuwa S, Yamaguchi N, Nakayama T, Nishiyama H, et al. Magnifying chromoendoscopic findings of early gastric cancer and gastric adenoma. Dig Dis Sci. 2011 Sep. 56 (9):2715-22. [Medline].

Li CQ, Li Y, Zuo XL, Ji R, Li Z, Gu XM, et al. Magnified and enhanced computed virtual chromoendoscopy in gastric neoplasia: a feasibility study. World J Gastroenterol. 2013 Jul 14. 19(26):4221-7. [Medline]. [Full Text].

Fujiwara S, Yao K, Nagahama T, Uchita K, Kanemitsu T, Tsurumi K, et al. Can we accurately diagnose minute gastric cancers (≤5 mm)? Chromoendoscopy (CE) vs magnifying endoscopy with narrow band imaging (M-NBI). Gastric Cancer. 2015 Jul. 18 (3):590-6. [Medline].

Kono Y, Takenaka R, Kawahara Y, Okada H, Hori K, Kawano S, et al. Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture. World J Gastroenterol. 2014 May 7. 20(17):5092-7. [Medline]. [Full Text].

Pohl J, Schneider A, Vogell H, Mayer G, Kaiser G, Ell C. Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut. 2011 Apr. 60(4):485-90. [Medline].

Allen JE, Sharma P. Polyp characterization at colonoscopy: Clinical implications. Best Pract Res Clin Gastroenterol. 2017 Aug. 31 (4):435-440. [Medline].

Sakamoto T, Saito Y, Nakajima T, Matsuda T. Comparison of magnifying chromoendoscopy and narrow-band imaging in estimation of early colorectal cancer invasion depth: a pilot study. Dig Endosc. 2011 Apr. 23(2):118-23. [Medline].

Efthymiou M, Allen PB, Taylor AC, Desmond PV, Jayasakera C, De Cruz P, et al. Chromoendoscopy versus Narrow Band Imaging for Colonic Surveillance in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2013 Sep. 19(10):2132-8. [Medline].

Chung SJ, Kim D, Song JH, Kang HY, Chung GE, Choi J, et al. Comparison of detection and miss rates of narrow band imaging, flexible spectral imaging chromoendoscopy and white light at screening colonoscopy: a randomised controlled back-to-back study. Gut. 2014 May. 63 (5):785-91. [Medline].

Shimura T, Ebi M, Yamada T, Hirata Y, Nishiwaki H, Mizushima T, et al. Magnifying chromoendoscopy and endoscopic ultrasonography measure invasion depth of early stage colorectal cancer with equal accuracy on the basis of a prospective trial. Clin Gastroenterol Hepatol. 2014 Apr. 12 (4):662-8.e1-2. [Medline].

Sakamoto T, Matsuda T, Nakajima T, Saito Y, Fujii T. Impact of clinical experience on type V pit pattern analysis using magnifying chromoendoscopy in early colorectal cancer: a cross-sectional interpretation test. BMC Gastroenterol. 2014 May 30. 14:100. [Medline]. [Full Text].

Gunther U, Kusch D, Heller F, Burgel N, Leonhardt S, Daum S, et al. Surveillance colonoscopy in patients with inflammatory bowel disease: comparison of random biopsy vs. targeted biopsy protocols. Int J Colorectal Dis. 2011 May. 26(5):667-72. [Medline].

Fock KM, Ang TL. Global epidemiology of Barrett’s esophagus. Expert Rev Gastroenterol Hepatol. 2011 Feb. 5(1):123-30. [Medline].

Canto MI. Chromoendoscopy and magnifying endoscopy for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2005 Jul. 3(7 Suppl 1):S12-5. [Medline].

Sharma P, Marcon N, Wani S, Bansal A, Mathur S, Sampliner R. Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett’s esophagus: a prospective multicenter study. Endoscopy. 2006 Dec. 38(12):1206-12. [Medline].

Ragunath K, Krasner N, Raman VS, Haqqani MT, Cheung WY. A randomized, prospective cross-over trial comparing methylene blue-directed biopsy and conventional random biopsy for detecting intestinal metaplasia and dysplasia in Barrett’s esophagus. Endoscopy. 2003 Dec. 35(12):998-1003. [Medline].

Hori K, Okada H, Kawahara Y, Takenaka R, Shimizu S, Ohno Y, et al. Lugol-voiding lesions are an important risk factor for a second primary squamous cell carcinoma in patients with esosphageal cancer or head and neck cancer. Am J Gastroenterol. 2011 May. 106(5):858-66. [Medline].

Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, Lara-Santos L, Guilherme M, Moreira-Dias L. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc. 2003 Apr. 57(4):498-504. [Medline].

Iishi H, Tatsuta M, Okuda S. Diagnosis of simultaneous multiple gastric cancers by the endoscopic Congo red–methylene blue test. Endoscopy. 1988 Mar. 20(2):78-82. [Medline].

Shaw D, Blair V, Framp A, Harawira P, McLeod M, Guilford P. Chromoendoscopic surveillance in hereditary diffuse gastric cancer: an alternative to prophylactic gastrectomy?. Gut. 2005 Apr. 54(4):461-8. [Medline].

Mitsuhashi J, Mitomi H, Koizumi W, Kikuchi S, Okayasu I, Saigenji K. Spraying of phenol red dye as a screening test for Helicobacter pylori infection in surgically resected stomach specimens. J Gastroenterol. 2003. 38(11):1049-52. [Medline].

Cho YS, Chae HS, Jang SN, Kim JS, Son HS, Kim HK. Comparison of the 13C-urea breath test and the endoscopic phenol red mucosal pH test in the quantification of Helicobacter pylori infection loading. Korean J Intern Med. 2008 Sep. 23(3):134-9. [Medline].

Graham DY, Shiotani A, El-Zimaity HM. Chromoendoscopy points the way to understanding recovery of gastric function after Helicobacter pylori eradication. Gastrointest Endosc. 2006 Nov. 64(5):686-90. [Medline].

Cha JM, Lee JI, Joo KR, Jung SW, Shin HP. A prospective randomized study on computed virtual chromoendoscopy versus conventional colonoscopy for the detection of small colorectal adenomas. Dig Dis Sci. 2010 Aug. 55(8):2357-64. [Medline].

Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut. 2004 Mar. 53(3):376-80. [Medline].

Hashimoto K, Higaki S, Nishiahi M, Fujiwara K, Gondo T, Sakaida I. Does chromoendoscopy improve the colonoscopic adenoma detection rate?. Hepatogastroenterology. 2010 Nov-Dec. 57(104):1399-404. [Medline].

Hurlstone DP, George R, Brown S. Novel clinical in vivo roles for indigo carmine: high-magnification chromoscopic colonoscopy. Biotech Histochem. 2007 Apr. 82(2):57-71. [Medline].

Basseri RJ, Basseri B, Papadakis KA. Dysplasia and cancer in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol. 2011 Feb. 5(1):59-66. [Medline].

Marion JF, Waye JD, Present DH, Israel Y, Bodian C, Harpaz N. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol. 2008 Sep. 103(9):2342-9. [Medline].

Bisschops R, Bessissow T, Joseph JA, Baert F, Ferrante M, Ballet V, et al. Chromoendoscopy versus narrow band imaging in UC: a prospective randomised controlled trial. Gut. 2017 Jul 11. [Medline].

Cohen-Mekelburg S, Schneider Y, Gold S, Scherl E, Steinlauf A. Advances in the Diagnosis and Management of Colonic Dysplasia in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2017 Jun. 13 (6):357-362. [Medline].

Ullman TA. Should chromoendoscopy be the standard of care in ulcerative colitis dysplasia surveillance?. Gastroenterol Hepatol (NY). 2010. 6(10):616-620.

Kiesslich R, Fritsch J, Holtmann M, Koehler HH, Stolte M, Kanzler S. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 2003 Apr. 124(4):880-8. [Medline].

Huang Q, Fukami N, Kashida H, Takeuchi T, Kogure E, Kurahashi T. Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc. 2004 Oct. 60(4):520-6. [Medline].

Meining A, Rosch T, Kiesslich R, Muders M, Sax F, Heldwein W. Inter- and intra-observer variability of magnification chromoendoscopy for detecting specialized intestinal metaplasia at the gastroesophageal junction. Endoscopy. 2004 Feb. 36(2):160-4. [Medline].

Stain

Property

Clinical Indication

Absorptive

Lugol solution (iodine and potassium

iodide)

Glycogen-containing normal squamous

epithelium is stained dark brown;

inflammation, columnar mucosa, dysplasia,

and cancer remain unstained

Esophageal squamous cell cancer and

dysplasia

Barrett esophagus

Methylene blue (methylthioninium

chloride)

Absorptive epithelial cells of the small

bowel, colon, and intestinal metaplasia at

any site are stained blue; dysplasia and

cancer is variably stained or unstained

Barrett esophagus

Gastric intestinal metaplasia and cancer

Chronic ulcerative colitis

Toluidine blue (tolonium chloride)

Nuclei of malignant cells are stained blue

Oral and esophageal squamous cell cancer

Crystal violet (methylrosaniline chloride

Absorbed into intestinal and neoplastic

cells; nuclear stain

Barrett esophagus

Colonic neoplasms

Contrast

Indigo carmine (indigotindisulfonate

sodium)

Nonabsorbed dark bluish dye highlighting

mucosal topography

Colonic neoplasms

Chronic ulcerative colitis

Reactive

Congo red (biphenylenenaphthadene

sulfonic acid)

Color change from red to dark blue/black

in presence of acid at pH 3

Ectopic gastric mucosa

Gastric cancer

Adequacy of vagotomy

Phenol red (phenolsulfonephthalein)

Color change from yellow to red in

presence of alkali (eg, from hydrolysis of

urea to ammonia and carbon dioxide by

urease-producing H. pylori)

H. pylori infection

Kondal Rao Kyanam Kabir Baig, MD Assistant Professor of Medicine (Gastroenterology), University of Alabama at Birmingham School of Medicine

Disclosure: Nothing to disclose.

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Society for Gastrointestinal Endoscopy, American Federation for Clinical Research, American Association for the Study of Liver Diseases, American College of Forensic Examiners Institute, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association

Disclosure: Nothing to disclose.

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chromoendoscopy

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