Chromoendoscopy with indigo carmine dye added to acetic acid in the diagnosis of gastric neoplasia: a prospective comparative study

• Published in: Gastrointestinal endoscopy Vol. 68; no. 4; pp. 635 - 641
• Main Authors: Sakai, Yuzo, MD, Eto, Reiko, MD, Kasanuki, Junji, MD, Kondo, Fukuo, MD, Kato, Kazuki, MD, Arai, Makoto, MD, Suzuki, Takuto, MD, Kobayashi, Michiko, MD, Matsumura, Tomoaki, MD, Bekku, Dan, MD, Ito, Kenichi, MD, Nakamoto, Shingo, MD, Tanaka, Takeshi, MD, Yokosuka, Osamu, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-10-2008; Elsevier
• Subjects: Acetic Acid; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Endoscopy - methods; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroscopy - methods; Humans; Indigo Carmine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Observer Variation; Prospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; endoscopic submucosal dissection; ESD; Stomach; Dyes; Diagnosis; Malignant tumor; Chromoendoscopy; Acetic acid; Comparative study; Cancer
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.03.1065

Background Conventional endoscopy and chromoendoscopy with indigo carmine dye are usually performed for recognizing adequate tumor-negative lateral margins for successful endoscopic resection of gastric neoplasia. However, chromoendoscopy with indigo carmine dye added to acetic acid has not been used for this purpose. Objective Our purpose was to compare the diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid with that of conventional endoscopy and chromoendoscopy with indigo carmine dye or acetic acid alone. Design Prospective study. Setting Social Insurance Funabashi Central Hospital. Patients Forty-seven consecutive patients (53 lesions) with early gastric cancer and gastric adenomas who underwent endoscopic submucosal dissection (ESD) from April 2006 to July 2007 were studied. Interventions All the lesions were examined by the endoscopic modalities before ESD, and the resected specimens were analyzed histopathologically. Main Outcome Measurements Two endoscopists independently evaluated the diagnostic performance of each image in terms of recognition of tumor borders with reference to macroscopic and histopathologic findings of resected specimens. We also conducted a substudy to assess interobserver variability. Results There was good interobserver agreement between the 2 endoscopists in this study (κ index = 0.764). The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was significantly greater than that of any of the other modalities (vs each: P < .005). Conclusions The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was better compared with conventional endoscopy and chromoendoscopy by using only indigo carmine dye or acetic acid. The applicability of this method for gastric neoplasia merits further investigation.