Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial.
BACKGROUND
Small adenomas may be missed during colonoscopy, but chromoscopy has been reported to enhance detection. The aim of this randomized-controlled trial was to determine the effect of total colonic dye spray on adenoma detection during routine colonoscopy.


METHODS
Consecutive outpatients undergoing routine colonoscopy were randomized to a dye-spray group (0.1% indigo carmine used to coat the entire colon during withdrawal from the cecum) or control group (no dye).


RESULTS
Two hundred fifty-nine patients were randomized, 124 to the dye-spray and 135 to the control group; demographics, indication for colonoscopy, and quality of the preparation were similar between the groups. Extubation from the cecum took a median of 9:05 minutes (range: 2:48-24:44 min) in the dye-spray group versus 4:52 minutes (range: 1:42-15:21 min) in the control group (p < 0.0001). The proportion of patients with at least 1 adenoma and the total number of adenomas were not different between groups. However, in the dye-spray group significantly more diminutive adenomas (<5 mm) were detected proximal to the sigmoid colon (p = 0.026) and more patients were identified with 3 or more adenomas (p = 0.002). More non-neoplastic polyps were detected throughout the colon in the dye-spray group (p = 0.003). There were no complications.


CONCLUSIONS
Dye-spray increases the detection of small adenomas in the proximal colon and patients with multiple adenomas, but long-term outcomes should be studied to determine the clinical value of these findings.
Brooker
Jim C
JC
Wolfson Unit for Endoscopy and Imperial Cancer Research Fund, St Mark's Hospital, Northwick Park, London, United Kingdom.
Saunders
Brian P
BP
Shah
Syed G
SG
Thapar
Catherine J
CJ
Thomas
Huw J W
HJ
Atkin
Wendy S
WS
Cardwell
Christopher R
CR
Williams
Christopher B
CB
D000236:Adenoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D004396:Coloring Agents; D007203:Indigo Carmine