Improved detection of colorectal neoplasms with selective use
of chromoendoscopy in 2005 consecutive patients |
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Authors: | A Trecca F Gaj G P Di Lorenzo M R Ricciardi M Silano A Bella M Sperone |
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Institution: | (1) Operative Units of Endoscopy and Gastroenterology, "Fabio Di Giovanbattista" International Health Union, Rome, Italy;(2) Second Surgical Clinic, Department of General Surgery La Sapienza University, Rome, Italy;(3) Istituto Superiore di Sanità, Rome, Italy |
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Abstract: | Background Colorectal cancer mortality is
decreased by endoscopic polypectomy, but conventional
colonoscopy may be inadequate for detecting subtle
colonic lesions.
Methods We selectively performed chromoendoscopy
in all patients undergoing colonoscopy
between January 1999 and December 2005 at the
International Health Union of Rome. Patients with a history
of colorectal polyps, inflammatory bowel disease,
colorectal surgery or coagulopathy and those with poor
bowel preparation were excluded from this analysis.
Whenever colonoscopy revealed suspicious mucosal
areas, dye-spraying with 0.2% indigo carmine solution
was also performed. Findings from conventional and dyespraying
views were classified morphologically, and specimens
were analyzed histologically. Non-adenomatous
lesions were classified as negative findings.
Results A
total of 2005 patients underwent conventional
colonoscopy and in 305 cases (15%) chromoendoscopy
was also performed. Conventional colonoscopy identified
508 neoplasms in 381 patients (19%). Selective chromoendoscopy
found an additional 244 neoplasms in 212 patients
(11%). Thus, chromoendoscopy was positive in 212 (70%)
of 305 patients in whom the examination was performed.
Overall, 56 large, ulcerated, advanced cancers and 696
non-advanced neoplasms were found. Of the 696 nonadvanced
neoplasms, 448 (65%) were polypoid and 248
(35%) were non-polypoid. All but 4 non-polypoid lesions
were only detected with chromoendoscopy. Of the 248
non-polypoid lesions, 12 (5%) were depressed and 236
(95%) were flat. Advanced histology was present in 39
non-polypoid lesions (15%) and was more common in
depressed lesions than in flat ones (58% vs. 13%;
p<0.001).
Conclusions Our study confirms the existence
of flat and depressed neoplasms in an Italian population.
The vast majority of non-polypoid lesions were only
detected by chromoendoscopy, and many lesions with
advanced histology were missed by conventional
colonoscopy. We therefore recommend selectively performing
chromoendoscopy when conventional
colonoscopy provides clues for non-polypoid lesions.
Therefore, endoscopists should be trained in the detection
of these subtle mucosal clues, as well as in the use of chromoendoscopy
to enhance their detection.
An erratum to this article is available at . |
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Keywords: | Colon cancer Colonoscopy Chromoendoscopy |
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