Chromoendoscopy with indigo carmine dye added to acetic acid in the diagnosis of gastric neoplasia: a prospective comparative study.
BACKGROUND
Conventional endoscopy and chromoendoscopy with indigo carmine dye are usually performed for recognizing adequate tumor-negative lateral margins for successful endoscopic resection of gastric neoplasia. However, chromoendoscopy with indigo carmine dye added to acetic acid has not been used for this purpose.


OBJECTIVE
Our purpose was to compare the diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid with that of conventional endoscopy and chromoendoscopy with indigo carmine dye or acetic acid alone.


METHODS
Prospective study.


METHODS
Social Insurance Funabashi Central Hospital.


METHODS
Forty-seven consecutive patients (53 lesions) with early gastric cancer and gastric adenomas who underwent endoscopic submucosal dissection (ESD) from April 2006 to July 2007 were studied.


METHODS
All the lesions were examined by the endoscopic modalities before ESD, and the resected specimens were analyzed histopathologically.


METHODS
Two endoscopists independently evaluated the diagnostic performance of each image in terms of recognition of tumor borders with reference to macroscopic and histopathologic findings of resected specimens. We also conducted a substudy to assess interobserver variability.


RESULTS
There was good interobserver agreement between the 2 endoscopists in this study (kappa index = 0.764). The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was significantly greater than that of any of the other modalities (vs each: P < .005).


CONCLUSIONS
The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was better compared with conventional endoscopy and chromoendoscopy by using only indigo carmine dye or acetic acid. The applicability of this method for gastric neoplasia merits further investigation.
21st Century Center of Excellence Program and Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Yuzo
Y
Sakai
Reiko
R
Eto
Junji
J
Kasanuki
Fukuo
F
Kondo
Kazuki
K
Kato
Makoto
M
Arai
Takuto
T
Suzuki
Michiko
M
Kobayashi
Tomoaki
T
Matsumura
Dan
D
Bekku
Kenichi
K
Ito
Shingo
S
Nakamoto
Takeshi
T
Tanaka
Osamu
O
Yokosuka
D019342:Acetic Acid; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
D007203:Indigo Carmine; D019342:Acetic Acid