Indigocarmine added to the water exchange method enhances adenoma detection - a RCT

Abstract

In a RCT, indigocarmine at 0.008% concentration, added to the water method, significantly enhanced further the effectiveness of the latter in detecting adenomas.

A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy

“…The method of scope insertion and withdrawal was the same as for WE. 16,17 Polyps were removed using biopsy forceps (<5 mm), cold snare (5-8 mm) or hot snare (>8 mm). All resected lesions were placed is separate specimen jars for histopathologic assessment.…”

“…Prior studies of chromoendoscopy (0.2% indigo carmine) using a dye spray method suggested an improved overall ADR 13 , 14 but dye spray can be tedious. We reported a controlled study comparing the effect of combined chromoendoscopy (0.008% indigo carmine) with water exchange (CWE) vs WE alone and showed that there was a significant increase in overall ADR and proximal ADR by CWE 15 , 16 . Combining chromoendoscopy with WE addresses some of the potential drawbacks of performing dye spray chromoendoscopy with traditional AI.…”

Adenoma detection with blue-water infusion colonoscopy: a randomized trial

“…With regard to BWIC versus standard WIC, a randomized controlled trial demonstrated a significant difference using blue water, despite a relatively small number of included patients (n = 168); the use of water colored by minute amounts of indigo carmine dye increased the ADR from 44 % to 62 % (P = 0.03) [36]. The concentration of indigo carmine (0.008 %) used in the BWIC technique was dramatically lower than that used in typical chromoendoscopy with indigo carmine, as recommended in patients with IBD or Lynch syndrome [37,38].…”

“…The number of small and large adenomas did not significantly increase with BWIC, nor did the number of advanced adenomas and right-sided diminutive adenomas. Previous studies on WIC and BWIC did not separately analyze diminutive polyps [24,29,36,41]. As BWIC seems only to result in the detection of more adenomas (resulting in an increased MAP) and not in greater detection of advanced adenomas, its clinical value in routine practice may be questioned.…”

Chromocolonoscopy for colorectal cancer screening: Dive into the Big Blue

“…9 In a group of 168 US veterans undergoing screening colonoscopy, the adenoma detection rate increased from 44% in the water arm to 62% (p=0.03) in the water-indigocarmine arm. These findings are intriguing, and are similar to a previous study published by the same group of investigators.…”