Comparative Efficacy and Safety of Anterograde vs. Retrograde Iodine Staining During Esophageal Chromoendoscopy: A Single-Center, Prospective, Parallel-Group, Randomized, Controlled, Single-Blind Trial.

Xu Tian,Wei-Qing Chen,Wei Yang

doi:10.3389/fmed.2021.764111

Xu Tian, Wei-Qing Chen + Show 1 more

Open Access

https://doi.org/10.3389/fmed.2021.764111

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Abstract

Background and Aim: Chromoendoscopy with iodine staining is an important diagnostic method for esophageal carcinomas or precancerous lesions. Unfortunately, iodine staining can be associated with numerous adverse events (AEs). We found that the starting position of spraying iodine solution is likely the main reason of causing AEs. We conducted this work to determine whether clinical outcomes from anterograde iodine staining were superior to those achieved after retrograde iodine staining.Methods: A total of 134 subjects with a health risk appraisal flushing (HRA-F) score of >6 for esophageal cancer were randomly assigned to receive anterograde or retrograde iodine staining in the esophagus. The primary endpoints were the pain and the amount of iodine solution consumption. The secondary endpoints were iodine-staining effect, detection yield, and response to starch indicator.Results: Nine patients suffered from pain and six patients revealed positive response to starch indicator in retrograde iodine-staining group; however, no patient reported pain (0/67) and all patients revealed a negative response to starch indicator in anterograde iodine-staining group. The amount of iodine solution consumption in anterograde iodine-staining group (4.97 mL) was significantly lower than that (6.23 mL) in retrograde iodine-staining group; however, the iodine-staining effect and detection yield were comparable between the two groups.Conclusions: Anterograde iodine staining during Lugol chromoendoscopy appears to be as effective, but significantly safer than retrograde iodine staining.

Highlights

It has been estimated that appropriately 6,04,100 new esophageal cancer cases and 5,44,076 deaths from esophageal cancer occurred in 2020 worldwide, which ranks sixth in incidence and eighth in cancer-related mortality [1]
Nine patients suffered from pain and six patients revealed positive response to starch indicator in retrograde iodine-staining group; no patient reported pain (0/67) and all patients revealed a negative response to starch indicator in anterograde iodine-staining group
Anterograde iodine staining during Lugol chromoendoscopy appears to be as effective, but significantly safer than retrograde iodine staining

Summary

Introduction

It has been estimated that appropriately 6,04,100 new esophageal cancer cases and 5,44,076 deaths from esophageal cancer occurred in 2020 worldwide, which ranks sixth in incidence and eighth in cancer-related mortality [1]. In early-stage esophageal cancer, the 5-year survival rate is expected to increase significantly to 85.0% [3]. Chromoendoscopy was developed to facilitate accurate detection of early-stage esophageal cancer. Among the several chromoendoscopy techniques available, chromoendoscopy with iodine staining is currently the ideal technique for early-detecting superficial esophageal cancer (SEC) [5] because it is relatively easy to perform [6] and sensitive to detect esophageal dysplasia and carcinoma [7]. Chromoendoscopy with iodine solution is often associated with a higher risk of adverse iodine-related events [8]. Chromoendoscopy with iodine staining is an important diagnostic method for esophageal carcinomas or precancerous lesions. Iodine staining can be associated with numerous adverse events (AEs). We conducted this work to determine whether clinical outcomes from anterograde iodine staining were superior to those achieved after retrograde iodine staining

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