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.
Wolfson Unit for Endoscopy and Imperial Cancer Research Fund, St Mark's Hospital, Northwick Park, London, United Kingdom.
Jim C
JC
Brooker
Brian P
BP
Saunders
Syed G
SG
Shah
Catherine J
CJ
Thapar
Huw J W
HJ
Thomas
Wendy S
WS
Atkin
Christopher R
CR
Cardwell
Christopher B
CB
Williams
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