Chromoendoscopy

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Chromoendoscopy

• Ellen M. Silvius BSN RN

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Chromoendoscopy

• Definition
• The topical application of stains or dye
  solutions during an endoscopy procedure.
• Promotes tissue
• Visualization
• Characterization
• Diagnosis

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Clinical Useof Chromoendoscopy

• Helps to detect dysplasia or early cancer
• in the GI tract in patients with
• Pre-malignant conditions
• and
• Hereditary Environmental factors that
  predispose them to cancer

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Studies include use of Chromoendoscopy in

• Squamous cell carcinoma of the esophagus
• Barrett's Esophagus
• Gastric cancer
• Colorectal polyps
• Chronic ulcerative colitis (UC)

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3 Categories of Stains used in Chromoendoscopy

• Absorptive Stains - are taken up by specific
  epithelial cells of the GI tract
• 2. Contrast Stains pool in the crevices of the
  mucosa (are not absorbed), highlight the mucosal
  topography
• 3. Reactive Stains undergo a color change as a
  response to the chemicals within the tissues

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Chromoendoscopy Staining Process

• Equipment Needed
• Staining Agent (from the 3 categories)
• Pre treatment solution required with some stains
• Spray Catheter
• Working channel in endoscope
• Post water rinse required after application of
  most stains

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Spraying techniques

• Target Spraying directed to specific area (ex.
  Colon polyp)
• Pan Staining spraying the entire surface of the
  organ
• (ex. Barretts esophagus)

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Dr. Joshua Korzenik
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Colorectal Cancer
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Increase Risk of Colorectal Cancerin patients
with UC

• 2.6- 5.4 fold increased risk of colorectal cancer
  in patients with UC compared to the general
  population
• Meta-analysis of 116 studies showed prevalence of
  colorectal cancer in UC to be between 3.7 and
  5.4 in pancolitis

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Colorectal cancer in patients with UC

• ? Development of colon cancer in patients with
  ulcerative colitis is believed to
• develop through a
• ? chronic inflammation ? dysplasia ? ?
  carcinoma sequence

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Colorectal cancer in patients with UC

• ? Dysplasia and Colitis associated-cancer can
  occur in macroscopically normal mucosa

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Patients with Ulcerative colitisStandard of Care

• Gold Standard
• During routine surveillance colonoscopy random
  biopsies are taken at 10-cm intervals of all four
  quadrants throughout the colon
• Recent data suggest that chromoendoscopy improves
  detection of dysplasia and early colon cancer

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Magnification Chromendosopy Improves detection of
Dysplasia in Ulcerative Colitis Patients

• 250 Patients underwant surviellance with
  magnification chromoendoscopy
• 18 patients had subtle villous changes resembling
  small intestinal mucosa
• Dysplasia was found in 9 (50) of the patients

Hamamoto N, Rubio C et al. Dig Endoscopy 2005
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Gastrointestinal Endoscopy 200919
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Chromoendoscopy Indigo Carmine Stain
Rutter, M D et al. Gut 200453256-260
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Nursing Considerations

• Prevent aspiration during esophageal procedures
• Avoidance of unintentional external exposure of
  stain solution
• Prevention of permanent staining to clothing by
  various agents used

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Bibliography

• ASGE Technology Committee, Wong K.S., Akler D.G.,
  et al Chromoendoscopy. Gastrointestinal
  Endoscopy 66. 639-649. 2007
• Davila R.E., Chromoendoscopy. Gastrointestinal
  Endoscopy Clinics of North America 19. 2009
• Rutter M.D., Saunders B.P., Schofield G., et al
  Pancolonic indigo carmine dye spraying for the
  detection of dyplasia in ulcerative colitis. Gut
  53. 256-260.2004