1. Chromocolonoscopy Sashi Sagi MBBS Asst Prof of Clinical Medicine Indiana University

2. Disclosures None

3. Outline What Why How When Guidelines

4. CHROMOENDOSCOPY Image-enhanced endoscopy through the use of dye spraying or optical techniques

5. CHROMOENDOSCOPY Image enhancement – Mucosal structures – Recognition of borders – Surface topography

6. CHROMOENDOSCOPY Dyes – Indigo Carmine – Methylene Blue – Crystal Violet

7. CHROMOENDOSCOPY Dyes – Indigo Carmine – Methylene Blue – Crystal Violet Digital – Narrow-band imaging (NBI) – Fujinon Intelligent Color Enhancement (FICE) – iScan

8. Chromocolonoscopy Is there a need ?

9. 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 ApplicationSpray-catheter /water pump Concentration 0.1% 0.03- 0.5% Duration1 min for staining Lasts ~ 20mins No wait time Lasts few minutes

10. Dye Application Laine L et al. Gastroenterology 2015;148:639–651.

11. Dye Application Adequate colon prep Lavage on insertion Start in the Cecum Suction excess dye

12. Laine L et al. Gastroenterology 2015;148:639–651.

14. 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.

15. Chromo vs HD Kahi CJ et al. Am J Gastroenterol 2010;105(6):1301–7

16. Chromo vs standard Dysplasia detection in IBD Laine L et al. Gastroenterology 2015;148:639–651.

17. 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.

18. 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.