![Page 1: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/1.jpg)
Chromocolonoscopy
Sashi Sagi MBBSAsst Prof of Clinical Medicine
Indiana University
![Page 2: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/2.jpg)
Disclosures
• None
![Page 3: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/3.jpg)
Outline
• What• Why• How• When• Guidelines
![Page 4: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/4.jpg)
CHROMOENDOSCOPY
Image-enhanced endoscopy through the use of dye spraying or optical techniques
![Page 5: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/5.jpg)
CHROMOENDOSCOPY
• Image enhancement – Mucosal structures – Recognition of borders – Surface topography
![Page 6: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/6.jpg)
CHROMOENDOSCOPY
• Dyes– Indigo Carmine– Methylene Blue– Crystal Violet
![Page 7: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/7.jpg)
CHROMOENDOSCOPY
• Dyes– Indigo Carmine– Methylene Blue– Crystal Violet
• Digital– Narrow-band imaging
(NBI)– Fujinon Intelligent
Color Enhancement (FICE)
– iScan
![Page 8: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/8.jpg)
Chromocolonoscopy
Is there a need ?
![Page 9: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/9.jpg)
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
![Page 10: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/10.jpg)
Dye Application
Laine L et al. Gastroenterology 2015;148:639–651.
![Page 11: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/11.jpg)
Dye Application
• Adequate colon prep• Lavage on insertion• Start in the Cecum• Suction excess dye
![Page 12: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/12.jpg)
Laine L et al. Gastroenterology 2015;148:639–651.
![Page 13: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/13.jpg)
Laine L et al. Gastroenterology 2015;148:639–651.
![Page 14: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/14.jpg)
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.
![Page 15: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/15.jpg)
Chromo vs HD
Kahi CJ et al . Am J Gastroenterol 2010;105(6):1301–7
![Page 16: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/16.jpg)
Chromo vs standard
• Dysplasia detection in IBD
Laine L et al. Gastroenterology 2015;148:639–651.
![Page 17: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/17.jpg)
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.
![Page 18: Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University](https://reader036.vdocuments.net/reader036/viewer/2022062401/5a4d1ae37f8b9ab0599781c1/html5/thumbnails/18.jpg)
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.