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.