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Chromoendoscopy

Author
Marcia Irene Canto, MD, MHS
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Chromoendoscopy involves the topical application of stains or pigments to improve tissue localization, characterization, or diagnosis during endoscopy [1]. Several agents have been described that can broadly be categorized as absorptive (vital) stains, contrast stains, and reactive stains (table 1). Absorptive stains (eg, Lugol's solution and methylene blue) diffuse or are preferentially absorbed across specific epithelial cell membranes. Contrast stains (eg, indigo carmine) highlight surface topography and mucosal irregularities by permeating mucosal crevices. Reactive stains (eg, Congo red and phenol red) undergo chemical reactions with specific cellular constituents, resulting in a color change. The stains used for chromoendoscopy are transient, unlike the stains used to tattoo lesions. (See "Tattooing and other methods for localizing colonic lesions", section on 'Tattooing'.)

Chromoendoscopy has been applied in a variety of clinical settings and throughout the gastrointestinal tract. Interest in chromoendoscopy increased with the development of technologies such as endoscopic mucosal resection and photodynamic therapy that require precise visual tissue characterization. In addition, chromoendoscopy is being used in conjunction with other advances in endoscopic imaging, such as magnification endoscopy, confocal endomicroscopy, and confocal endocytoscopy. (See "Magnification endoscopy" and "Confocal laser endomicroscopy and endocytoscopy".)

Compared with other evolving diagnostic modalities, such as fluorescence spectroscopy, fluorescence endoscopy, and optical coherence tomography, the equipment needed for chromoendoscopy is widely available. Furthermore, the techniques are simple, quick, inexpensive, and safe. However, the interpretation of the findings is not always straightforward, and, like many endoscopic techniques, the impact of chromoendoscopy on clinical outcomes relative to standard endoscopic and histologic methods has not been established in large controlled trials.

This topic will review chromoendoscopy, which generally refers to the application of stains or pigments by spraying through a catheter. Endoscopic tattooing (the injection of dye through a needle to mark a site for future identification), optical coherence tomography, narrow band imaging, magnification endoscopy, and autofluorescence endoscopy are discussed separately. (See "Tattooing and other methods for localizing colonic lesions", section on 'Tattooing' and "Optical coherence tomography in the gastrointestinal tract" and "Barrett's esophagus: Evaluation with narrow band imaging" and "Magnification endoscopy" and "Barrett's esophagus: Evaluation with autofluorescence endoscopy".)

EQUIPMENT

Minimal equipment is required for chromoendoscopy, and the reagents used are generally widely available. The procedure is carried out using standard endoscopic equipment. In addition, a special spray catheter (such as the Olympus PW-5L) is essential, since it delivers a fine mist to the mucosa (movie 1). The catheters are reusable and last several years, even when used frequently. A new biopsy channel cap is preferable to minimize the amount of stain that leaks out.

                        

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Literature review current through: Nov 2016. | This topic last updated: Wed Jan 13 00:00:00 GMT+00:00 2016.
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