title: Chromoendoscopy with indigo carmine in flexible sigmoidoscopy screening: does it improve the detection of adenomas in the distal colon and rectum?
abstract: OBJECTIVE
  The aim of our study was to determine whether chromoendoscopy with indigo carmine significantly improves the detection of adenomas in the distal colon and rectum and therefore could become routine in flexible sigmoidoscopy screening.
  
  
  METHODS
  Between 2001- 2003, two sigmoidoscopies, the first conventional, the second with chromoendoscopy, were performed in a "back-to-back" design by two experienced endoscopists in a series of 55 patients. All lesions were classified with regard to position and size before and after staining, then endoscopically removed and referred to two experienced pathologists.
  
  
  RESULTS
  55 patients, mean age 60 +/- 9.8 (42-79) years, 34 (61.8%) men and 21 (38.2%) women were enrolled. After staining, 47 patients had 373 visible lesions, 306 (82%) < 3mm, 47 (12.6%) 3- 5 mm and 20 (5.4%) > 5 mm. Histologically, 215 (57.7%) were hyperplastic polyps, 27 (7.2%) adenomas and 131 (35.1%) other lesions. With chromoendoscopy, in 17 of the 47 patients (36.2%) 27 adenomas (15 <or= 5 mm and 12 > 5 mm) were detected. Chromoendoscopy significantly improved the detection of adenomas <or= 5 mm (p<0.01). Regarding the detection of adenomas larger than 5 mm, there was no significant difference between conventional sigmoidoscopy and chromoendoscopy. The chi-square test was performed for comparisons between the number of lesions detected by standard sigmoidoscopy and chromoendoscopy.
  
  
  CONCLUSIONS
  Chromoendoscopy with indigo carmine allows the detection of significantly more adenomas <or= 5 mm in the distal colon and rectum. Thus, flexible sigmoidoscopy with routine chromoendoscopy could become an option in colorectal cancer screening when colonoscopy is unavailable or not accepted by the patient.
authors.affiliation: Department of Endoscopy, Municipal Clinical Hospital, Str. Tabacarilor 11, 400139 Cluj-Napoca, Romania. ratiunadia@hotmail.com
authors.forename: Nadia
authors.initials: N
authors.lastname: Ratiu
authors.forename: Cornelia
authors.initials: C
authors.lastname: Gelbmann
authors.forename: Heiko R
authors.initials: HR
authors.lastname: Rath
authors.forename: Hans
authors.initials: H
authors.lastname: Herfarth
authors.forename: Frank
authors.initials: F
authors.lastname: Kullmann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schölmerich
authors.forename: Helmut
authors.initials: H
authors.lastname: Messmann
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D012812:Sigmoidoscopy
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine