Background

Chromoendoscopy is an endoscopic technique that uses stains during endoscopy to highlight differences in mucosa, as well as dysplastic and malignant changes that are not apparent in white light. Chromoendoscopy is used to increase the detection rates for various pathologic processes during endoscopy. Chromoendoscopy is often used in surveillance of the esophagus for Barrett esophagus, evaluation of polyps in the colon, and surveillance of dysplasia in inflammatory bowel disease (IBD).^{[1, 2, 3, 4, 5]}

Initial evaluations of computerized virtual chromoendoscopy for screening colonoscopy showed efficacy similar to that of chromoendoscopy, without the logistical difficulties or preparing and applying vital dyes.^{[6, 7]} Magnification endoscopy, spectroscopy, confocal laser endomicroscopy and endocytoscopy have important roles in the evaluation of IBD and surveillance of chronic ulcerative colitis (UC).^{[8, 9, 10]} Use of these techniques in Barrett esophagus has also led better detection of dysplasia, particularly in the absence of discrete lesions.^[11]

Indications

Chromoendoscopy has been used in the evaluation of Barrett esophagus,^{[12, 13, 14]} esophageal adenocarcinoma,^[15] gastric metaplasia and adenocarcinoma,^{[16, 17, 18, 19]} colon polyps,^{[20, 21]} colon cancer,^{[22, 23, 24, 25, 26]} and surveillance in IBD.^[27]

Contraindications

Contraindications for chromoendoscopy would be any of the usual contraindications for endoscopy or a history of an allergic reaction to the dye or stain used in the specific clinical situation.

Chromoendoscopy is not routinely performed during general endoscopy. It is performed in centers that specialize in this field or on a case-by-case basis as indicated by the clinical situation and dictated by the experience of the endoscopist and the center.

Periprocedure

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Table 1. Properties of and Clinical Indications for Common Stains Used in Endoscopy^[1]

Table 1. Properties of and Clinical Indications for Common Stains Used in Endoscopy ^[1]

Stain	Property	Clinical Indication
Absorptive
Lugol solution (iodine and potassium iodide)	Glycogen-containing normal squamous epithelium is stained dark brown; inflammation, columnar mucosa, dysplasia, and cancer remain unstained	Esophageal squamous cell cancer and dysplasia Barrett esophagus
Methylene blue (methylthioninium chloride)	Absorptive epithelial cells of the small bowel, colon, and intestinal metaplasia at any site are stained blue; dysplasia and cancer is variably stained or unstained	Barrett esophagus Gastric intestinal metaplasia and cancer Chronic ulcerative colitis
Toluidine blue (tolonium chloride)	Nuclei of malignant cells are stained blue	Oral and esophageal squamous cell cancer
Crystal violet (methylrosaniline chloride	Absorbed into intestinal and neoplastic cells; nuclear stain	Barrett esophagus Colonic neoplasms
Contrast
Indigo carmine (indigotindisulfonate sodium)	Nonabsorbed dark bluish dye highlighting mucosal topography	Colonic neoplasms Chronic ulcerative colitis
Reactive
Congo red (biphenylenenaphthadene sulfonic acid)	Color change from red to dark blue/black in presence of acid at pH 3	Ectopic gastric mucosa Gastric cancer Adequacy of vagotomy
Phenol red (phenolsulfonephthalein)	Color change from yellow to red in presence of alkali (eg, from hydrolysis of urea to ammonia and carbon dioxide by urease-producing H. pylori)	H. pylori infection

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