Dye Spraying Research Articles

High Definition Colonoscopy (HDC) vs. Dye Spraying Chromo-colonoscopy (DSC) in Screening Patients With Long-standing Inflammatory Bowel Disease (IBD)

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Characterization of Mucosal Dysbiosis of Early Colonic Neoplasia.

Aberrant crypt foci (ACF) are the earliest morphologically identifiable lesions in the colon that can be detected by high-definition chromoendoscopy with contrast dye spray. Although frequently associated with synchronous adenomas, their role in colorectal tumor development, particularly in the proximal colon, is still not clear. The goal of this study was to evaluate the profile of colon-adherent bacteria associated with proximal ACF and to investigate their relationship to the presence and subtype of synchronous polyps present throughout the colon. Forty-five subjects undergoing a screening or surveillance colonoscopy were included in this retrospective study. Bacterial cells adherent to the epithelia of ACF and normal mucosal biopsies were visualized by in situ hybridization within confocal tissue sections. ACF showed significantly greater heterogeneity in their bacterial microbiome profiles compared with normal mucosa. One of the bacterial community structures we characterized was strongly correlated with the presence of synchronous polyps. Finally, using DNA mass spectrometry to evaluate a panel of colorectal cancer hotspot mutations present in the ACF, we found that three APC gene mutations were positively associated with the presence of Instestinibacter sp., whereas KRAS mutations were positively correlated with Ruminococcus gnavus. This result indicates a potential relationship between specific colon-associated bacterial species and somatically acquired CRC-related mutations. Overall, our findings suggest that perturbations to the normal adherent mucosal flora may constitute a risk factor for early neoplasia, demonstrating the potential impact of mucosal dysbiosis on the tissue microenvironment and behavior of ACF that may facilitate their progression towards more advanced forms of neoplasia.

The impact of chromoendoscopy for surveillance of the duodenum in patients with MUTYH-associated polyposis and familial adenomatous polyposis

Duodenal polyposis and cancer have become a key issue for patients with familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). Almost all patients with FAP will develop duodenal adenomas, and 5% will develop cancer. The incidence of duodenal adenomas in MAP appears to be lower than in FAP, but the limited available data suggest a comparable increase in the relative risk and lifetime risk of duodenal cancer. Current surveillance recommendations, however, are the same for FAP and MAP, using the Spigelman score (incorporating polyp number, size, dysplasia, and histology) for risk stratification and determination of surveillance intervals. Previous studies have demonstrated a benefit of enhanced detection rates of adenomas by use of chromoendoscopy both in sporadic colorectal disease and in groups at high risk of colorectal cancer. We aimed to assess the effect of chromoendoscopy on duodenal adenoma detection, to determine the impact on Spigelman stage and to compare this in individuals with known pathogenic mutations in order to determine the difference in duodenal involvement between MAP and FAP. A prospective study examined the impact of chromoendoscopy on the assessment of the duodenum in 51 consecutive patients with MAP and FAP in 2 academic centers in the United Kingdom (University Hospital Llandough, Cardiff, and St Mark's Hospital, London) from 2011 to2014. Enhanced adenoma detection of 3 times the number of adenomas after chromoendoscopy was demonstrated in both MAP (P= .013) and FAP (P= .002), but did not affect adenoma size. In both conditions, there was a significant increase in Spigelman stage after chromoendoscopy compared with endoscopy without dye spray. Spigelman scores and overall adenoma detection was significantly lower in MAP compared with FAP. Chromoendoscopy improved the diagnostic yield of anomas in MAP and FAP 3-fold, and in both MAP and FAP this resulted in a clinically significant upstaging in Spigelman score. Further studies are required to determine the impact of improved adenoma detection on the management and outcome of duodenal polyposis.

A Randomized Trial Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy.

Dye spraying chromoendoscopy (DCE) is recommended for the detection of colonic neoplastic lesions in inflammatory bowel disease (IBD). The majority of neoplastic lesions are visible endoscopically and therefore targeted biopsies are appropriate for surveillance colonoscopy. To compare three different techniques for surveillance colonoscopy to detect colonic neoplastic lesions in IBD patients: high definition (HD), (DCE), or virtual chromoendoscopy (VCE) using iSCAN image enhanced colonoscopy. A randomized non-inferiority trial was conducted to determine the detection rates of neoplastic lesions in IBD patients with longstanding colitis. Patients with inactive disease were enrolled into three arms of the study. Endoscopic neoplastic lesions were classified by the Paris classification and Kudo pit pattern, then histologically classified by the Vienna classification. A total of 270 patients (55% men; age range 20-77 years, median age 49 years) were assessed by HD (n=90), VCE (n=90), or DCE (n=90). Neoplastic lesion detection rates in the VCE arm was non-inferior to the DCE arm. HD was non-inferior to either DCE or VCE for detection of all neoplastic lesions. In the lesions detected, location at right colon and the Kudo pit pattern were predictive of neoplastic lesions (OR 6.52 (1.98-22.5 and OR 21.50 (8.65-60.10), respectively). In this randomized trial, VCE or HD-WLE is not inferior to dye spraying colonoscopy for detection of colonic neoplastic lesions during surveillance colonoscopy. In fact, in this study HD-WLE alone was sufficient for detection of dysplasia, adenocarcinoma or all neoplastic lesions.

Endoscopic Therapeutic Approach for Dysplasia in Inflammatory Bowel Disease.

Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD) induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (≥20 mm), endoscopic submucosal dissection (ESD) or ESD with snaring (simplified or hybrid ESD) is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

Product of Batik Ikat Motif on Leather in Sumbersekar, Dau Malang, Indonesia

The study aimed to describe the product of batik ikat on leather generated by people of Sumbersekar, Dau, Malang, in terms of process, motifs and color quality. The type of research is qualitative. The collected data are about process of making batik ikat motif on tanned leather by people of Sumbersekar village and quality of its products that is obtained by observation, interviews, and laboratory analysis. Data analysis techniques are using data presentation and draw conclusions or verification. The results showed: 1) process of making leather with batik ikat motif on it is started by making the design, pattern, transferring the pattern onto the leather, binding and coloring using dye technique. To create texture of its motif, people use pebbles and small pieces of bamboo tied to the leather and use tie dye technique and spray technique for the coloring, both techniques combined with wax coating; 2) the batik motifs made by people of Sumbersekar are inspired by environment in their village, such as leaves, flowers, etc. The motifs commonly made in Sumbersekar are parang bunga, wiru jumputan, bunga jumputan, and wiru bunga, those are made by ikat system and jumputan technique; 3) the colors applied to the tanned leather with batik ikat motif are synthetic dyes based on naphtol. Quality of the tanned leather’s adhesion strength of paint is 180.16 gram/cm2 with the assessment of leaching resistance, perspiration resistance, scrub resistance, and resiliency durability, are about 5. It means that quality of tanned leather with batik ikat motif produced by people of Sumbersekar is very good.

Distinct Transcriptional Changes and Epithelial-Stromal Interactions Are Altered in Early-Stage Colon Cancer Development.

Although the progression of mutated colonic cells is dependent upon interactions between the initiated epithelium and surrounding stroma, the nature of these interactions is poorly understood. Here, the development of an ultrasensitive laser capture microdissection (LCM)/RNA-seq approach for studying the epithelial and stromal compartments of aberrant crypt foci (ACF) is described. ACF are the earliest identifiable preneoplastic lesion found within the human colon and are detected using high-definition endoscopy with contrast dye spray. The current analysis focused on the epithelium of ACF with somatic mutations to either KRAS, BRAF, or APC, and expression patterns compared with normal mucosa from each patient. By comparing gene expression patterns among groups, an increase in a number of proinflammatory NF-κB target genes was identified that was specific to ACF epithelium, including TIMP1, RELA, and RELB Distinct transcriptional changes associated with each somatic mutation were observed and a subset of ACF display BRAF(V600E)-mediated senescence-associated transcriptome characterized by increased expression of CDKN2A Finally, LCM-captured ACF-associated stroma was found to be transcriptionally distinct from normal-appearing stroma, with an upregulation of genes related to immune cell infiltration and fibroblast activation. Immunofluorescence confirmed increased CD3(+) T cells within the stromal microenvironment of ACF and an abundance of activated fibroblasts. Collectively, these results provide new insight into the cellular interplay that occurs at the earliest stages of colonic neoplasia, highlighting the important role of NF-κB, activated stromal fibroblasts, and lymphocyte infiltration. Fibroblasts and immune cells in the stromal microenvironment play an important role during the earliest stages of colon carcinogenesis. Mol Cancer Res; 14(9); 795-804. ©2016 AACR.

PTH-078 Increasing Adherence to BSG Guidelines for Cancer Surveillance in IBD - Effective Strategies

Introduction Colorectal cancer (CRC) is the fourth commonest cancer worldwide. Inflammatory bowel disease (IBD) is one of the many risk factors. Ulcerative colitis (UC) and Crohn’s colitis both increase the risk of developing CRC by greater than 15 fold compared to the population without IBD. The National Institute for Health and Care Excellence (NICE) produced evidence-based recommendations in 2011 on the colonoscopic surveillance for prevention of CRC in people with UC, Crohn’s disease or adenomas. These are broadly consistent with those in the BSG 2010 guidelines. One of the key recommendations is that chromoscopy (pan-colonic dye spray) is the technique of choice. Methods We compared results from two audits (2012/13 and 2014/15) performed at Barking, Havering and Redbridge University Hospitals (BHRUH), each assessing adherence to the key features of the BSG guidelines. The interventions made between auditing included; adding a ‘surveillance’ option to the endoscopy request form, specifying ‘dye spray’ on the request and clerical staff dedicating 3 points (i.e more time) to perform the procedure. Results 100 patients undergoing surveillance colonoscopy from September 2014 to August 2015 at BHRUH (49% male, 65% UC) were analysed compared with 35 patients in the period September 2012 to August 2013 (66% male, 97% UC). The number of chromoscopies performed for CRC surveillance in IBD patients increased from 1 in the initial audit to 30 in the follow up audit, after implementation of changes (p = 0.003). 23% of colonoscopies were performed in patients with less than 10 years duration of disease in the first audit compared with 9% in the second (p = 0.03). Polyps and dysplasia were identified in 20% and 8.6% of patients in 2013, respectively. This is compared to 31% (p = 0.21) and 8% (p = 0.91)in 2015. Conclusion Adaptations to the way in which endoscopies are requested at BHRUH along with increased awareness amongst clerical staff booking the more time consuming surveillance colonoscopy has resulted in a significant increases in chromoscopy rates. However, there has not been a corresponding increase in the number of polyps or adenomas detected. This may be explained by the overall improvement in the quality of white light endoscopy and technical ability of endoscopists. Further work comparing chromoscopy, narrow band imaging and white light endoscopy in the detection of early cancers in IBD is required. References 1 Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas. NICE Guidelines, 2011. 2 Guidelines for colorectal cancer for screening and surveillance in moderate and high risk groups (update from 2002). BSG Guidelines, 2010. Disclosure of Interest None Declared

Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type.

Colorectal laterally spreading tumor granular type (LST-G) is generally divided into two subtypes based on morphology. Here, we retrospectively investigated the clinical significance of a concrete, objective LST-G subclassification. This study examined 636 consecutive cases that were resected endoscopically or surgically. LST-G was subclassified as follows: Type 1, a lesion with homogenous uniform granules with uniform (<5 mm) nodules; Type 2, a lesion with granules and small nodules (≥5 mm, <10 mm); or Type 3, a lesion accompanied by large nodules (≥10 mm). For the validation study, 194 images were compiled from 97 cases investigated using conventional colonoscopy and chromoendoscopy with indigo carmine dye spraying. Images were distributed in a randomized order to students without prior endoscopy experience, less-experienced endoscopists (LEE group), and highly experienced endoscopists (HEE group). Diagnostic accuracy and interobserver agreement were then evaluated. There was no submucosal invasion in Type 1 lesions. The incidence of deep submucosal invasive carcinoma was higher for Type 3 lesions than for Type 2 lesions. Interobserver agreement was good in each group. Diagnostic accuracy was higher in the HEE group than in the student and LEE groups. Chromoendoscopy had a higher accuracy rate than conventional colonoscopy in the LEE and HEE groups (LEE, 0.74 vs 0.69, P < 0.05; HEE, 0.84 vs 0.78, P < 0.05). This subclassification of LST-G according to the diameters of granules and nodules was both useful for choosing therapeutic strategies in the clinical setting and universally applicable.

624 Final Results of a Randomized Study Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy

624 Final Results of a Randomized Study Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy

DOP080. Final results of a randomised study comparing high-definition colonoscopy alone with high- definition dye spraying and electronic virtual chromoendoscopy using iSCAN for detection of colonic neoplastic lesions during IBD surveillance colonoscopy

DOP080. Final results of a randomised study comparing high-definition colonoscopy alone with high- definition dye spraying and electronic virtual chromoendoscopy using iSCAN for detection of colonic neoplastic lesions during IBD surveillance colonoscopy

Forward-Viewing Colonoscopy Versus Full-Spectrum Endoscopy (Fuse) for Dysplasia Detection With and Without Chromoendoscopy In Inflammatory Bowel Diseases: A Prospective, Randomized-order, Crossover Tandem Surveillance Colonoscopy Study

Traditional forward-viewing colonoscopy (FVC) is impeded by a narrow field of view of <170 degrees with adenoma “miss-rates” of 24-42%. This limitation impairs dysplasia surveillance in chronic colitis. Chromoendoscopy improves visualisation of dysplasia but has never been used with FUSE, which provides 330 degree visualisation. This study compares FVC and FUSE with and without chromoendoscopy for the identification of dysplasia in IBD. This was a prospective, randomized-order, crossover tandem colonoscopy trial at an academic IBD centre. Inclusion criteria were left sided or extensive colitis for >10 years disease duration, primary sclerosing cholangitis (PSC) or previous dysplasia. Patients underwent same-day, back-to-back tandem colonoscopy with FVC (PCF/CF 180/190, Olympus, Japan) and the FUSE colonoscope (EndoChoice, USA) under propofol sedation. Order randomization was computer-generated. Patients and endoscopist were masked to group allocation until immediately prior to colonoscopy. All lesions detected during initial colonoscopy were removed and any additional lesions detected on subsequent colonoscopy were then removed. Chromoendoscopy (CE) was with methylene blue dye spray, additional random biopsies were performed during the second colonoscopy. The primary endpoint was dysplasia-yield. The secondary endpoint was detection of dysplasia on random biopsy versus CE-targeted biopsies. Logistic regression and Chi square statistics were performed. Twenty-four participants were randomized (16 males, mean age 37 years, Crohn’s colitis n=16, ulcerative colitis n=8, mean duration of colitis: 13.5 years). Two subjects had prior low-grade dysplasia and two had primary sclerosing cholangitis. Ileal-intubation rate was 100%. 46% were randomized to FVC first and 54% to FUSE first. All patients had cross-over CE as the second procedure. On a per-lesion analysis for lesion detection, FUSE odds ratio (OR) was 4.86 (95% CI: 1.43-16.49) vs FVC OR: 2.33 (95% CI: 0.74-7.13; P<0.01). Dysplasia detection with FUSE had an OR: 7.67 (95% CI: 9.85-69.6) vs FVC OR: 2.90 (95% CI: 0.50-16.67). Combined hyperplastic/ dysplasia detection with FUSE had an OR: 3.80 (95% CI: 1.07-13.52) vs FVC OR: 1.74 (95% CI 0.52-5.74). The mean lesion detection with FUSE vs FVC was 1.62 vs 0.45 (P<0.042), with mean dysplasia detection of 0.30 vs 0.09 respectively (P=0.21). FUSE +/- CE versus FVC +/- CE had a mean dysplasia detection of 0.25 vs 0.04 (P=0.04) and mean lesion detection of 2.25 vs 0.67 respectively (P=0.003). Lesional and dysplasia miss rates are shown in Table 1. Mean caecal intubation times for FUSE and FVC were 4.7 and 4.6 minutes respectively (ns). Dysplasia yield on targeted biopsies with CE yield was 10.8% vs 0% on random biopsies (P<0.0001). FUSE significantly increased dysplasia identification in IBD surveillance. We confirmed the dysplasia yield of random biopsies in the setting of IBD is extremely low.Table 1Miss rates for FUSE and forward-viewing colonoscope (FVC) for lesions and dysplasiaLesion miss rateDysplasia miss rateFUSE31%0%FVC78%66.7% Open table in a new tab

PWE-362 Detection of neoplasia using dye spray chromoendoscopy in patients with a high risk of familial colorectal cancer: Abstract PWE-362 Table 1

Introduction Patients at high risk of familial colorectal cancer require surveillance colonoscopy to identify and remove polyps before malignant transformation can occur. Colonoscopy sensitivity rates vary and its effectiveness depends on user ability, adequate bowel preparation and procedure duration. Furthermore, the majority of polyps occur in the right colon and are characteristically flatter than those found in the left colon, rendering identification difficult. As such, recent guidelines have advocated the use of dye spray chromoendoscopy (DSC) to aid detection rates. 1 Our study assesses the use of chromoendoscopy at a district general hospital and whether polyp detection was higher in those undergoing surveillance colonoscopy when dye spray was used. Method High risk patients were selected from our local endoscopy database Scorpio®. High risk was defined by a diagnosis of Lynch Syndrome or High Moderate risk as per BSG guidelines (i.e. a lifetime risk of colorectal cancer of >10%). 2 We retrospectively measured polyp detection rate, procedure duration, adequacy of bowel preparation, withdrawal time, histopathology, and the use of 0.02% indigocarmine dye spray versus white light colonoscopy (WLI). Statistical analysis was performed using chi-square test and 2 tailed T test for binary and continuous variables respectively. Results 101 patients were included in this study (62 High Moderate risk and 39 Lynch Syndrome). WLI alone was performed for 77 patients, with DSC performed in 24. Significantly more polyps were detected by the use of dye spray, with an average polyp count of 0.49 for WLI versus 1.79 for DSC (P = 0.00332). There was a predominance of right sided lesions in this cohort. A longer withdrawal time may also be a factor in polyp detection rate. Table 1highlights our main findings. Conclusion The use of DSC improves polyp detection in those undergoing surveillance colonoscopy for high risk familial colorectal cancer. Prolonged withdrawal time may account for an increased adenoma detection rate, or may be a function of polypectomy procedures. We recommend a large randomised controlled trial be performed to determine the true efficacy of this chromoendoscopy in high familial risk patients. Disclosure of interest None Declared. References Kaminski MF. Advanced imaging for detection and differentiation of colorectal neoplasia. ESGE Guideline Cairns SR. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups. BSG Guideline. Gut 2010

PTU-327 An evaluation of the effect of using an acetic acid protocol for the detection of dysplasia in barrett’s oesophagus in a district general hospital setting: Abstract PTU-327 Table 1

Introduction Studies have suggested that mucosal enhancement techniques, such as acetic acid (AA) spray may increase detection of advanced dysplasia during surveillance of Barrett’s oesophagus. A standardised AA protocol was adopted by 3 consultants and a nurse endoscopist (NE) from 2011, other endoscopists continued a conventional methodology for surveillance. We aimed to investigate the impact of the use of a standard protocol (HD image in WL, FICE assessment and use of 3% AA dye spray, with targeted biopsies and Seattle protocol biopsies) on the detection of all dysplasia and advanced dysplasia (HGD, or in-situ adenocarcinoma). Method We searched the HICCS Endoscopic Reporting System for all endoscopies where Barrett’s oesophagus was detected between October 2010 and October 2014 (n = 587). Only specific surveillance cases were included (index and specific recall cases excluded). Endoscopy reports were checked and histology results retrieved from the Welsh Clinical Portal system. Differences in dysplasia detection rates for the AA Protocol (AA) or ‘standard’ white light endoscopy (WLE) were tested using the Chi-squared test, with significance level set at p Results In the 4 year study period, 367 Barrett’s surveillance procedures were performed in 220 patients. The AA protocol was applied during 86 procedures, standard WLE in 269 procedures. The dysplasia rates are shown in the Table 1. There was a significant increase in the detection rate of all types of dysplasia (p Conclusion Introduction of a Standard AA Protocol in our Health Board was associated with higher detection of dysplasia compared with white light endoscopies performed during the same time interval. The training of a nurse endoscopist to provide this service has proved both feasible and effective. All surveillance patients now attend pre-booked lists where AA protocol is used. Disclosure of interest None Declared.

327 A Randomized Comparison of High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Dysplastic Lesions During IBD Surveillance Colonoscopy

327 A Randomized Comparison of High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Dysplastic Lesions During IBD Surveillance Colonoscopy

Use Chromoendoscopy for Lynch Syndrome

Previous study findings suggest that chromoendoscopy (pancolonic dye spraying) improves detection of adenomas in Lynch syndrome. Based on general

P146. Detection and characterization of colonic dysplastic lesions in IBD surveillance colonoscopy - a randomised comparison of high definition alone with high definition dye spraying and electronic virtual chromoendoscopy using iSCAN

P146. Detection and characterization of colonic dysplastic lesions in IBD surveillance colonoscopy - a randomised comparison of high definition alone with high definition dye spraying and electronic virtual chromoendoscopy using iSCAN

Chromoendoscopy for colorectal cancer surveillance in patients with inflammatory bowel disease.

Chromoendoscopy utilizes colorimetric techniques to increase detection of lesions that are difficult to see or cannot be seen with conventional white light endoscopy. Multiple studies have demonstrated that chromoendoscopy with dye spraying significantly increases the detection of dysplastic lesions in patients with chronic inflammatory bowel disease (IBD) of the colon undergoing colonoscopy. Furthermore, chromoendoscopy may obviate the need for random biopsies and pending additional studies and may allow increased intervals between surveillance exams, reducing costs while increasing the sensitivity for detection of dysplasia per exam. Despite convincing data supporting the use of chromoendoscopy for IBD colonic surveillance, it is seldom utilized outside of academic centers. Here, we review the current approach to colorectal cancer surveillance in IBD focusing on the data supporting the use of chromoendoscopy including its use in a community setting and offer practical recommendations for incorporating chromoendoscopy as a routine part of surveillance in IBD regardless of practice setting.

The Effect of Indigocarmine on Improvement of the Polyp Detection Rate during Colonoscopic Examination with Hood Cap.

Background/AimsHood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations.MethodsFrom January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying.ResultsPrior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (≤0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups.ConclusionHood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.

High-definition vs. standard-definition endoscopy with indigo carmine for the invivo diagnosis of colonic polyps.

There is growing evidence that indigo carmine chromoendoscopy is effective for the invivo diagnosis of colonic polyps. However, the impact of colonoscope resolution on diagnostic accuracy has not been investigated. We aimed to compare the effectiveness of invivo diagnosis of small colonic polyps using indigo carmine dye spray with standard-definition and high-definition colonoscopes. Procedures were performed using Fujinon colonoscopes and EPX 4400 processor. Fujinon standard-definition (SD) and high-definition (HD) colonoscopes were used, with the endoscopist blinded to colonoscope definition. Polyps <10 mm were assessed using 0.2% indigo carmine dye spray, with the predicted diagnosis recorded. In each case the kind of colonoscope (SD or HD) was recorded. Polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis was compared with the true histology to calculate the accuracy, sensitivity and specificity of invivo assessment using either SD or HD scopes. In total 237 polyps <10 mm in size were examined. There was no statistically significant difference for any of the measured parameters between SD and HD assessments, with an accuracy, sensitivity and specificity of 89%, 91% and 87% with SD colonoscopes and 92%, 96% and 84% with HD colonoscopes. The accuracy of invivo assessment of small colonic polyps with indigo carmine dye spray is excellent with standard-definition colonoscopes and is not improved with high-definition colonoscopes.